老年脓毒症患者并发急性肾损伤的相关危险因素及预后分析  

Risk factors and prognosis of acute kidney injury in elderly patients with sepsis

作　　者：丁毅[1,2] 方强[2] 吴晓梁[2] 裘晓蕙[1] 

机构地区：[1] 宁波市医疗中心李惠利医院 [2]浙江大学医学院附属第一医院ICU, 杭州310003

出　　处：《中华老年医学杂志》2015年第6期641-644,共4页Chinese Journal of Geriatrics

基　　金：宁波市自然科学基金资助项目（2012A610231）

摘　　要：目的 探讨在ICU老年脓毒症患者并发急性肾损伤（AKI）的危险因素和老年脓毒症患者的预后. 方法 回顾性分析2010年5月至2014年5月浙江大学医学院附属第一医院ICU病房老年脓毒症患者共108例.根据是否发展为急性肾损伤把患者分为AKI组和非AKI组,比较两组的临床特征,实验室和生理学数据,并以多因素Logistic回归方程分析脓毒症并发AKI相关的独立危险因素.并对临床转归进行分析总结. 结果 108例ICU老年脓毒症患者,60例发生AKI,发生率为55.6％.脓毒症AKI组与脓毒症非AKI组比较基础肾小球滤过率、平均动脉压均较低（t=4.536、3.28）,凝血酶原时间值（t=3.053）、多器官功能衰竭（MODS）评分（t=2.201）、急性生理学与慢性健康状况评分系统评分（t=3.423）,合并休克（x2=5.400）、2周内外科手术史较脓毒症非AKI组高（x2=5.625）（均P＜0.05）.多因素Logistic回归分析提示,平均动脉压（OR=0.833）、基础肾小球滤过率（OR=0.776）、MODS评分（OR=2.039）是老年脓毒症患者发生AKI的独立危险因素.AKI组住院死亡率（P=0.001）,住ICU时间（P=0.026）和总住院时间（P=0.042）均高于非AKI组. 结论 ICU老年脓毒症患者并发AKI的独立危险因素为平均动脉压、基础肾小球滤过率、MODS评分,脓毒症AKI患者住院病死率高,住ICU时间及总住院时间延长.Objective To investigate the risk factors and prognosis of acute kidney injury （AKI） in elderly patients with sepsis in intensive care unit （ICU）.Methods Clinical data of 108 elderly patients diagnosed as sepsis admitted in ICU in our hospital,from May 2010 to May 2014 were analyzed retrospectively.Patients were divided into two groups：the AKI group and the non-AKI group.Clinical characteristics,laboratory and physiologic data were compared between groups.Multivariate Logistic regression analysis was used to analyze the independent risk factors for AKI in these patients,and clinical outcome was retrospectively analyzed.Results Among the 108 elderly patients,60 patients developed AKI and the incidence was 55.6%.Baseline glomerular filtration rate （GFR） and mean arterial pressure （MAP） were lower in the AKI group than in non-AKI group （t=4.536 and 3.28）.Prothrombin time （PT） （t=3.053）,multiple organ dysfunction score （MODS） （t =2.201）,acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ） score （t=3.423）,the incidence of septic shock （x2 =5.400） and patients undergoing surgical operation within two weeks （x2 =5.625） were higher or longer in AKI group than in non-AKI group （all P〈0.05）.Multivariate Logistic regression analysis showed that MAP （OR =0.833）,baseline GFR （OR=0.776）,MODS （OR=2.039） were independent risk factors for AKI occurrence.Hospital mortality,length of stay in ICU and hospitalization time were higher or longer in AKI group than in non-AKI group （P=0.001,0.026 and 0.042）.Conclusions MAP,baseline GFR and MODS are the independent risk factors for AKI occurrence in elderly adults with sepsis in ICU.Hospital mortality,length of stay in ICU and hospitalization time are increased in sepsis patients combined with AKI.

关 键 词：脓毒症 急性肾损伤 危险因素 预后 

分 类 号：R459.7[医药卫生—急诊医学] R692.5[医药卫生—治疗学]