程庆砾 - 中华老年多器官疾病杂志.DOCVIP

·述 评· 老年多器官衰竭的肾脏问题 程庆砾 （解放军总医院南楼临床部肾脏病科，北京 100853） 【摘 要】老年多器官衰竭（MOFE）常伴有急性肾损伤（AKI），预后极差。肾脏保护是MOFE临床诊治中的一个重要问题。近年来AKI在MOFE中的发病原因和病理生理机制有不少新进展，如“血压正常的AKI”和“跨肾灌注压”等概念对理解老年AKI的发生具有重要意义。一些新的生物标记物在临床上的应用使AKI的早期诊断成为可能。肾脏专科医师的及时会诊、认识在MOFE治疗过程中对肾功能保护的各种方法，如按照肾功能水平计算用药剂量和间隔时间、采用合适的血管活性药物提升血压、调整合理的机械通气参数等，均可以改善MOFE患者的临床预后。 【关键词】老年人；多器官功能衰竭；急性肾功能不全 【中图分类号】 R692.5；R592 【文献标识码】 A 【DOI】 ? Multiple organ failure in elderly: role of the kidney CHENG Qing-Li (Department of Geriatric Nephrology, Chinese PLA General Hospital, Beijing 100853, China) 【Abstract】 Acute kidney injury (AKI) is, generally, a common problem in the elderly with multiple organ failure (MOFE) and what’s more, it significantly contributes to the poor outcome in these patients. In this way, it is of great importance to protect kidney in the diagnosis and treatment of MOFE. In recent years, significant progress has been made in the role of AKI in the etiology and pathophysiology of MOFE, “normotensive ischemic acute renal failure” and “transrenal perfusion pressure” for example. These increasing new concepts are of meaningful values in the understanding of AKI in the elderly. Some new biomarkers make it possible of the early diagnosis of AKI in the MOFE in clinical practice. Multiple strategies may greatly improve the outcomes in the MOFE patients with AKI, including timely consultation with nephrologist, and various managements to protect renal functions during the treatment of MOFE, such as drug dose and intervals based on renal function, suitable vasoactive drug to increase blood pressure, and rational adjustment of mechanical ventilation parameters. 【Key words】 aged; multiple organ failure; acute kidney injury This work was supported by the National Natural Science Foundation of China 81170312) and the Natural Science Foundation of Beijing (7122163). Corresponding author: CHENG Qing-Li, E-mail: qlcheng64@163.com 老年多器官衰竭（multiple organ failure in the elderly，MOFE）患者器官衰竭的顺序通常为肺、心、肝、肾，一