| Objective:Stroke is a common disease in neurology department,morbidity, mortality and disability rate are high, as cerebrovascular disease and heart disease, malignant tumor form the top three leading causes of death in humans. Acute stroke patients, mostly consisting of elderly patients with a history of hypertension, diabetes, coronary heart disease.After onset,suffer from a large number of complications,such as disturbance of consciousness, lack of food intake, the application of dehydration,etc, all of which lead to the occurrence of acute renal failure (ARF), while ARF has become one of the most serious complications of acute stroke. However, the prognosis of ARF is not ideal.Though guardianship means and renal replacement therapy have made great progress, the prognosis of ARF is still far from satisfactory. The occurrence of ARF adds to the difficulty of treatment and mortality of stroke, but early prevention,prompt correction,and proper treatment can play a significant role in the positive outcome of the disease. My article aims at exploring the causes of hospitalized acute stroke patients with ARF, clinical features, treatment and prognosis, offering clinical reference for the treatment and prevention of acute stroke patients with ARF.Methods and materials:1.We selected stroke patients diagnosed in the Department of Neurology of Shandong Provincial Hospital from January2005to June2012as subjects for the survey, a total of5218cases including ischemic stroke and hemorrhagic stroke,2.207cases of the above mentioned stroke patients screened met the standard, according to diagnostic criteria for ARF.3.We collected the clinical data of all cases included in the study, including: general information, history of present illness, past history, imaging studies, complications, renal failure risk factors, renal failure clinical symptoms and signs, laboratory test results, treatment measures, outcome. The retrospective study was used to analyze and summarize the clinical features. 4. All data were statistically analyzed using the statistical package SPSS18.0version, the measurement data between the two groups using t test; data calculating between the two groups using chi-square test; P<0.05being statistically significant.Results:1.Among the ARF patients as subjects in this study, with an average age of (72.3±10.3) years old, subjects of65-75years old and80-85years old were two peaks of incidence. Trouble with ARF or without ARF after Stroke made a significant difference in the age of patients(P <0.05).2. Among the total of5218cases of stroke patients in this study.,the male with ARF were92cases (44.44%), female with ARF being115cases (55.56%); while men cover2509cases (50.07%), with women without ARF2502cases (49.93%). Which indicated no significant difference in their gender whether patients suffer from ARF or not after stroke (P>0.05).3.Cases of ischemic stroke number is4514,cases of hemorrhagic stroke cases is704among whom171cases had occurrence of ischemic stroke with ARF,36cases of hemorrhagic stroke with ARF. Different types of stroke patients after stroke showed a significant difference in incidence of ARF (P<0.05).4.Stroke section made no significant difference in different types of patients with ARF after stroke.Different types of stroke in patients with ARF has much to do with cortex lesions area (P <0.05).Different types of stroke in patients with ARF has no significant correlation with their blood supply obstacles site (P>0.05). Lacunar infarction patients with ARF were26cases (12.56%); atherosclerotic cerebral infarction were complicated with ARF patients,55(26.57%).5.ARF in patients with previous history of hypertension patients were131cases (63.29%), ARF patients with a history of diabetes57cases (27.54%), indicating that the post-stroke patients with ARF and non-ARF patients were significantly different. Different type of stroke in patients had significant differences (P<0.05). patients of ARF with previous history of coronary heart disease were58cases (28.02%), patients of ARF with a history of atrial fibrillation53(25.60%), among whom, no significant difference was shown in post-stroke patients with ARF and non-ARF patients. Namely,different type of stroke in patients had no significant difference (P>0.05). Among patients with ARF there were57cases of former smokers (27.54%),33cases previously drinking (15.95%), Therefore there was no significant difference in post-stroke patients with ARF and non-ARF patients (P>0.05). Smoking rates made a significant difference in different types of stroke (P<0.05), while alcohol ratio was of no significant difference.in different types of stroke in patients (P>0.05).6.Patients with ARF after stroke are more conscious persons,the rate of disturbance of consciousness was40.58%.Ischemic stroke patients are prone to lethargy.Level of consciousness in hemorrhagic stroke patients is more serious,and prone to coma.7. Blood pressure (SBP, DBP) in patients with hemorrhagic stroke was significantly higher than that in patients with ischemic stroke (P<0.05).The average of triglycerides in post-stroke patients with ARF was (1.47±0.53) mmol/L, the average of total cholesterol in stroke patients with ARF being (5.66±2.35) mmol/L, indicating no significant difference in stroke patients with ARF and non-ARF,and no significant difference in patients with hemorrhagic stroke and ischemic stroke patients.(P>0.05) The avarage level of blood glucose in patients with ARF after stroke was (8.34±3.24) mg/dl, indicating the average blood glucose levels of patients with ischemic stroke were significantly higher that in patients with hemorrhagic stroke (P<0.05). BUN of stroke patients with ARF ranged from (13.85±5.33) mmol/L, with an average SCr of (163.3±28.91) umol/L, in ARF patients after stroke.The average BUN/Cr was (113.5±38.64) in stroke patients with ARF while stroke patients with ARF had a urine specific gravity average (1.02±0.005). The average of urinary protein in patients with ARF after stroke was (0.54±0.22)g, indicating no significant difference in patients with hemorrhagic stroke compared with patients with ischemic stroke(P>0.05).ARF patients after stroke had the osmotic average (298.2±20.41) mOsm/L. Namely, the osmotic pressure of patients with hemorrhagic stroke was significantly higher than that in patients with ischemic stroke (P<0.05).The calcium average is of (2.23±0.62) mmol/L in ARF post-stroke patients,patients with ARF after stroke averaging (3.89±0.81) mmol/L in serum potassium. The average serum sodium of post-stroke patients with ARF being (142.1±5.92) mmol/L, serum chloride average was (101.4±2.71) mmol/L ARF in patients after stroke. Electrolyte levels change significantly in different type of stroke (P<0.05).8.From the first day to the onset of ARF the total amount of20%mannitol had been applied to patients is (358.5±72.36) g, while patients with hemorrhagic stroke had a much higher dosage of mannitol than patients with ischemic stroke (P<0.05). For patients hospitalised after stroke, a total of39cases (18.85%) patients with ARF, had urine catheterization.The first5days of daily fluid when ARF occurred, there was a total of (3288±725.4)g/d、(2924±691.1)g/d in and out, indicating no significant difference to patients with ischemic and hemorrhagic states (P>0.05).9. A total of75cases (36.23%) of stroke patients with ARF died within30days after onset, which was significantly higher than stroke patients without ARF (P<0.05).111cases (53.62%) of ARF patients after onset of stroke had their state improved,which was significantly lower than with non-ARF patients (P<0.05). Namely,there was no significant difference between ischemic and hemorrhagic patients who died within in30days (P>0.05).Conclusion:The main factors and clinical features of acute stroke patients with ARF found in the current study are as follows:1) age factor.2) Hypertension, DM are risk factors for the development of ARF.3) Hemorrhagic stroke is more prone to have the occurrence of ARF compared with ischemic stroke.4) Hemorrhagic stroke which belonged to subcortical lesions is likely to cause ARF.5) Consciousness impairment in patients is prone to renal hypofusion inducing ARF.6) Excessive use of mannitol will promote the occurrence of ARF, balance disorders of water and electrolyte.7) ARF incidence adds to the risk of death with stroke. |
PDF Full Text Request