液体正平衡对严重脓毒症性急性肾损伤预后的影响  

Effect of positive fluid balance on prognosis of severe septic acute kidney injury

作　　者：郭妍妍[1] 曹延会[1] Guo Yanyan;Cao Yanhui(ICU,The First Affiliated Hospital of Harbin Medical University,Harbin 150001,China)

机构地区：[1]哈尔滨医科大学附属第一医院重症监护室

出　　处：《中华保健医学杂志》2020年第1期9-11,共3页Chinese Journal of Health Care and Medicine

基　　金：黑龙江省卫生计生委科研课题(2017041)

摘　　要：目的分析液体正平衡对严重脓毒症性急性肾损伤预后的影响。方法回顾性分析哈尔滨医科大学附属第一医院2014年3月~2019年2月收治的108例严重脓毒症性急性肾损伤患者临床资料,按预后分为死亡组(76例)与存活组(32例),比较两组患者一般临床资料;按急性肾损伤病情分为全球肾病预后组织(AKI)分期Ⅰ期组(12例)、AKIⅡ期组(31例)与AKIⅢ期组(33例),比较各组患者液体平衡量、急性生理学与慢性健康状况(APACHEⅡ)评分情况、血清肌酐(SCr)水平,分析液体平衡量对预后的影响。结果存活组液体平衡量、APACHEⅡ评分、序贯器官衰竭评分(SOFA)及血清SCr水平均低于死亡组,差异均有统计学意义(P <0.05)。全部患者中AKIⅠ期组12例(42.86%)、AKIⅡ期组31例(75.61%)与AKIⅢ期组33例(84.61%),AKIⅡ期组与AKIⅢ期组病死率均高于AKIⅠ期组,差异有统计学意义(P <0.05)。AKIⅠ期组的液体平衡量、APACHEⅡ评分、血清SCr与AKIⅡ期组与AKIⅢ期组比较差异均有统计学意义(P <0.05);AKIⅡ期组的APACHEⅡ评分和血清SCr与AKIⅢ期组组间比较差异均有统计学意义(P <0.05)。多因素回归分析显示,液体平衡量、APACHEⅡ评分和SCr是预后的独立危险因素(P <0.05)。ROC曲线判断患者预后,液体平衡量AUC为0.706,最佳截断值为1 209.83 ml,敏感性为70.81%,特异性为68.52%。结论液体正平衡与严重脓毒症性急性肾损伤预后及病情严重程度有关,液体超负荷可导致病死率增高,对预后有一定预测价值。Objective To analyze the effect of positive fluid balance on prognosis of severe septic acute kidney injury.Methods The clinical data of 108 patients with severe sepsis and acute renal injury admitted to the hospital from March 2014 to February 2019 were analyzed retrospectively.According to the prognosis,they were divided into death group and survival group.The general clinical data of the two groups were compared.According to the condition of acute renal injury,they were divided into AKIⅠgroup,AKIⅡ group and AKIⅢ group.The fluid balance,acute physiology and chronic health status(APACHE Ⅱ)of each group were compared.The effects of fluid balance on prognosis were analyzed. Results The fluid balance,Apache Ⅱ score,SOFA score and serum SCR level in the survival group were lower than those in the death group(P < 0.05).Among all the patients,12 patients(42.86%)in AKI stage Ⅰ group,31 patients(75.61%)in AKI stage Ⅱ group and 33 patients(84.61%)in AKI stage Ⅲ group.The mortality of AKI stage Ⅱ group and AKI stage Ⅲ group was higher than that of AKI stage Ⅰ group,the difference was statistically significant.There were significant differences in Apache Ⅱ score,serum SCR between AKI Ⅰ group and AKI Ⅱ group,AKI Ⅱ group and AKI Ⅲ group,AKI Ⅰ group and AKI Ⅲ group(P < 0.05).There was significant difference between AKI I group and AKI Ⅱgroup and AKI Ⅲ group(P < 0.05).Multivariate regression analysis showed that fluid balance,Apache Ⅱ score and SCR were independent risk factors for prognosis(P < 0.05).Under ROC curve,AUC was 0.706,the best cutoff value was 1209.83 ml,sensitivity was 70.81%,specificity was 68.52%. Conclusion Positive fluid balance is related to the prognosis and severity of severe septic acute kidney injury.Fluid overload can lead to increased mortality,which has a certain predictive value for prognosis.

关 键 词：脓毒症 肾损伤 液体平衡 预后 

分 类 号：R692[医药卫生—泌尿科学]