摘 要

腎衰竭在小動物臨床上是常見且治療上相當棘手的疾病。為提供獸醫師在診斷、治療、與如何正確的評估預後時之參考資料，本研究以回溯性方式調查自民國九十年十月起到九十三年十月止，至台灣大學生農學院附設動物醫院就診之犬貓，經診斷為腎衰竭後並接受住院治療之病例，以邏輯迴歸分析病畜的性別、年齡、臨床症狀、初次就診時之血液檢查數值、採取的治療方式、診斷結果、及是否伴隨有其他疾病的發生等因子，對於治療的反應（短期預後）是否具有影響力。結果共收集439隻腎衰竭犬病例，貓病例則有113例。根據本研究結果，犬貓性別分佈以雄性居多；年齡分佈以七歲以上之老年犬貓為主要族群；品種則是以混種犬貓最為常見；消化道症狀為最常被觀察到之臨床症狀，其中又以食慾廢絕、嘔吐發生的比例最高。經邏輯回歸分析，在腎衰竭犬方面，病犬發病的年齡、臨床上是否有出現神經症狀（包括痙攣、震顫、昏迷）、或心血管/呼吸症狀（包括黏膜蒼白、呼吸急促）、診斷結果為急性腎衰竭或慢性腎衰竭、及初次就診時血中尿素氮數值高低等五項因子，對於治療後的反應具有顯著影響力。在腎衰竭貓方面，則以有無出現神經症狀、診斷結果為腎性腎衰竭或非腎性腎衰竭、及初次就診時血容比數值的高低等三項因子，會顯著影響治療後之反應。因此我們可以用這幾項因子，作為臨床上評估腎衰竭犬貓短期預後好壞之指標。至於其他因子方面，包括：病畜性別、其他相關之臨床症狀，像是泌尿系統異常、其他症狀（包括：體重減輕、低體溫、脫水）、及初次就診時血中肌酸酐的濃度、和是否伴隨有其他的疾病發生等，則對於短期預後不具有顯著影響力。

Abstract

Renal failure is one of the most common diseases in small animal practice and is usually difficult to treat. The aim of this study is to offer veterinarians informations of how to diagnose, treat, and evaluate the prognosis of a renal failure patient in it’s first attending. Four hundred and thirty-nine dogs and 113 cats were collected from hospitalized renal failure cases in NTUVH between October 2001 and October 2004. The majority of sex in this study was male and age over 7 years old was the dominant group. The most common breed of dogs and cats in this study were mixed breed. Gastrointestinal symptoms were the most common clinical signs, especially anorexia and vomiting. According to the result of logistic regression analysis, the responses to treatments were significantly influenced by the patient’s age, occurrence of neurological signs or cardiovascular and respiratory signs, diagnosis result, concentration of serum blood urea nitrogen when first attending in canine population. While in feline group, the responses to treatments were significantly influenced by occurrence of neurological signs, diagnosis result and values of packed cell volume. There were no significant disparities between short-term prognosis and sex, other clinical signs, serum creatinine concentration or other diseases followed with the renal failure.

目 錄

頁次

誌謝 ………………………………………………………… Ⅴ
中文摘要 ………………………………………………………… Ⅶ
英文摘要 ………………………………………………………… Ⅸ

第一章 緒言…………………………………………………… 1

第二章 文獻探討……………………………………………… 2
第一節 急性腎衰竭…………………………………………… 2
2.1.1 簡介…………………………………………………… 2
2.1.2 引起急性腎衰竭常見之原因………………………… 4
2.1.3 急性腎衰竭之診斷與臨床呈象……………………… 7
第二節 慢性腎衰竭…………………………………………… 9
2.2.1 簡介…………………………………………………… 9
2.2.2 慢性腎衰竭之診斷與臨床呈象……………………… 10
2.2.3 慢性腎衰竭引起之繼發性疾病及治療……………… 12
第三節 腎衰竭之治療………………………………………… 14
2.3.1 治療目的……………………………………………… 14
2.3.2 傳統內科療法………………………………………… 15
2.3.3 透析療法……………………………………………… 17
2.3.4 飲食療法……………………………………………… 20
2.3.5 腎臟移植……………………………………………… 21
第四節 預後評估……………………………………………… 22
2.4.1 預後評估之目的……………………………………… 22
2.4.2 急性腎衰竭與慢性腎衰竭之鑑別診斷要素………… 24
2.4.3 影響預後因子之探討………………………………… 25

第三章 材料與方法…………………………………………… 27
第一節 研究病例之收集……………………………………… 27
第二節 病例之紀錄與分類…………………………………… 28
第三節 資料分析與方法……………………………………… 30

第四章 資料分析結果（一）：犬資料………………………… 31
第一節 犬基本資料分析……………………………………… 31
第二節 犬臨床症狀、診斷、治療資料分析………………… 34
第三節 犬急、慢性腎衰竭之診斷與預後相關因子………… 39
之探討
第四節 影響腎衰竭犬預後因子之分析………………………
45

第五章 資料分析結果（二）：貓資料………………………… 48
第一節 貓基本資料分析……………………………………… 48
第二節 貓臨床症狀、診斷、治療資料分析………………… 50
第三節 貓急、慢性腎衰竭之診斷與預後相關因子………… 55
之探討
第四節 影響腎衰竭貓預後因子之分析……………………… 61

第六章 討論…………………………………………………… 64
第一節 腎衰竭犬貓基本資料分析討論……………………… 64
第二節 腎衰竭犬貓之臨床症狀、診斷、治療……………… 67
與伴隨發生疾病之分析討論
第三節 影響腎衰竭預後相關因子之討論…………………… 72

第七章 結論…………………………………………………… 77

參考文獻 ………………………………………………………… 78

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