高目标血压降低老年脓毒症休克患者急性肾损伤的发生风险  

High target blood pressure reduces the risk of acute kidney injury in elderly patients with septic shock

作　　者：陈万[1] 段文龙 吕立文[1] 陈春霞[2] 唐宇涛[1] CHEN Wan;DUAN Wen-long;LV Li-wen;CHEN Chun-xia;TANG Yu-tao(Emergency Department,The People's Hospital of Guangxi Zhuang Autonomous Region,Nanning 530021,China.2Research Department,The People's Hospital of Guangxi Zhuang Autonomous Region)

机构地区：[1]广西壮族自治区人民医院急诊科,广西南宁530021 [2]广西壮族自治区人民医院科研部,广西南宁530021

出　　处：《内科急危重症杂志》2021年第3期224-227,共4页Journal of Critical Care In Internal Medicine

基　　金：广西科技攻关计划项目(桂科攻:No:15277007);广西自然基金项目(No:2019JJA140418);广西卫生健康委计划项目(No:Z20201115);广西医疗卫生适宜技术项目(No:S2020076)。

摘　　要：目的:探讨高/低目标血压对老年脓毒症休克患者发生急性肾损伤(AKI)的影响。方法:选取2017年1月-2019年6月广西壮族自治区人民医院急诊重症监护病房(EICU)住院的老年脓毒症休克患者91例,随机分成高目标血压组(A组48例)和低目标血压组(B组43例),目标平均动脉压(MAP)分别控制为80~85 mmHg和65~70 mmHg均给予5 d脓毒症休克集束治疗。收集患者基线资料,使用床旁超声检测患者肾阻力指数(RI),尿气分析检测患者尿氧分压。比较2组治疗前、后急性生理与慢性健康状况评估(APACHEⅡ)评分、多器官功能障碍综合征(MODS)评分、RI、肾血流评分、尿氧压、肌酐、尿素氮等情况,Logistics回归分析AKI危险因素。结果:治疗后,与B组比较,A组患者APACHEⅡ评分、MODS评分、血乳酸水平、RI低于B组,而肾血流分级评分高于B组(P均<0.05);Logistics回归分析提示MAP是老年脓毒症休克患者发生AKI的独立危险因素。结论:脓毒症休克集束治疗中高目标血压有助于改善老年患者肾灌注,降低AKI发生风险。Objective:To investigate the effect of high/low target blood pressure on acute kidney injury(AKI)in elderly patients with septic shock.Methods:Totally,91 elderly patients with septic shock who were hospitalized in the Emergency Intensive Care Unit(EICU)of the People's Hospital of Guangxi Zhuang Autonomous Region from January 2017 to June 2019 were selected and randomly divided into two groups:high target blood pressure group(group A,n=48)and low target blood pressure group(group B,n=43),the target mean arterial pressure(MAP)was controlled to 80-85 mmHg and 65-70 mmHg respectively,and they were all given 5 days of septic shock cluster treatment.Baseline data of the patients were collected,renal resistance index(RI)of the patients was detected by bedside ultrasound,and urine oxygen partial pressure of patients was detected by urinalysis.The acute physiology and chronic health evaluation(APACHEⅡ)score,multiple organ dysfunction syndrome(MODS)score,RI,renal blood flow score,urinary oxygen pressure,creatinine,and blood urea nitrogen and other conditions were compared between the two groups before and after treatment.Logistics regression analysis was used to analyze the risk factors for AKI.Results:After treatment,as compared with group B,the APACHEⅡscore,MODS score,serum lactic acid level and RI in group A were significantly reduced,and the renal blood flow grading score was significantly increased(all P<0.05).Logistic regression analysis suggested that MAP was an independent risk factor for AKI in elderly patients with septic shock.Conclusion:High target blood pressure in septic shock cluster therapy can help improve renal perfusion in elderly patients and reduce the risk of AKI.

关 键 词：血压 老年 脓毒症 肾损伤 

分 类 号：R692.5[医药卫生—泌尿科学]