连续性血液净化治疗脓毒症合并急性肾损伤患者预后的危险因素  

Risk factors for the prognosis of patients with sepsis complicated with acute kidney injury treated by continuous blood purification

作　　者：徐广民 吴化奎[1] 曹子君 金磊[1] XU Guangmin;WU Huakui;CAO Zijun;JIN Lei(Department of Critical Care,Huainan First People’s Hospital,Huainan Anhui 232000,China)

机构地区：[1]淮南市第一人民医院重症医学科,安徽淮南232000

出　　处：《临床与病理杂志》2021年第12期2877-2881,共5页Journal of Clinical and Pathological Research

摘　　要：目的:探讨连续性血液净化(continuous blood purification,CBP)治疗脓毒症合并急性肾损伤(acute kidney injury,AKI)患者预后的危险因素。方法:回顾性分析80例接受CBP治疗的脓毒症合并AKI患者的临床资料,记录患者28 d转归情况,将死亡的29例患者纳入预后不良组,将存活的51例患者纳入预后良好组。收集并比较两组患者的基线临床资料,采用多因素logistic回归分析影响预后的危险因素。结果:单因素分析显示:两组患者在年龄、合并糖尿病、AKI分期、C反应蛋白(C-reactive protein,CRP)水平、序贯器官衰竭估计(sequential organ failure assessment,SOFA)评分、急性生理学与慢性健康状况评分系统Ⅱ (Acute Physiology and Chronic Health Evaluation Ⅱ,APACHE Ⅱ)评分、机械通气、感染性休克、重症监护病房(intensive care unit,ICU)住院时间等方面比较,差异具有统计学意义(P<0.05);logistic回归分析结果显示:AKI分期Ⅲ期、感染性休克、 APACHE Ⅱ评分≥2 0是CBP治疗脓毒症合并AKI患者预后不良的独立危险因素(P<0.05)。结论:AKI分期及APACHE Ⅱ评分高、感染性休克是CBP治疗脓毒症合并AKI患者预后不良的独立危险因素。Objective:To investigate the risk factors for the prognosis of patients with sepsis and acute kidney injury(AKI) treated by continuous blood purification(CBP).Methods:The clinical data of 80 patients with sepsis and AKI treated with CBP were retrospectively analyzed.The prognosis of the patients 28 d after the treatment was recorded.Twenty-nine patients who died were included into a poor prognosis group,and 51 patients who survived were included into a good prognosis group.The baseline clinical data of the two groups were collected and compared.Multivariate logistic regression analysis was used to determine the risk factors affecting the prognosis.Results:Univariate analysis showed that there were significant differences in age,diabetes mellitus,AKI stage,C-reactive protein(CRP),sequential organ failure assessment(SOFA) score,Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ) score,mechanical ventilation,septic shock,intensive care unit(ICU) stay between the two groups(P<0.05);logistic regression analysis showed that AKI stage Ⅲ,septic shock and APACHE Ⅱ score ≥20 were independent risk factors for poor prognosis of patients with sepsis and AKI treated with CBP(P<0.05).Conclusion:AKI stage,high APACHE Ⅱ score,and septic shock are independent risk factors for poor prognosis of sepsis patients with AKI treated with CBP.

关 键 词：脓毒症 急性肾损伤 连续性血液净化 全身炎症反应综合征 危险因素 

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