脓毒症相关急性肾损伤患者外周低灌注与病死率的关系  

Relationship between peripheral hypoperfusion and mortality in patients with sepsis associated acute kidney injury

作　　者：郭蕾[1] 马琪 吴媛[1] 张小玲[1] 侯彦丽[1] 赵玉杰[1] 骆艳妮[1] 王小闯[1] GUO Lei;MA Qi;WU Yuan;ZHANG Xiaoling;HOU Yanli;ZHAO Yujie;LUO Yanni;WANG Xiaochuang(Department of Intensive Care Unit,the Second Affiliated Hospital of Xi'an Jiaotong University,Xi'an Shaanxi 710000,China)

机构地区：[1]西安交通大学第二附属医院重症医学科,陕西西安710000

出　　处：《中国急救复苏与灾害医学杂志》2024年第9期1151-1156,共6页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：国家自然科学基金资助项目(编号:81670049)。

摘　　要：目的探讨脓毒症相关急性肾损伤(SA-AKI)患者外周低灌注与病死率的关系。方法采用回顾性分析,选择2020年3月—2023年12月期间入住西安交通大学第二附属医院重症医学科的151例脓毒症患者作为研究对象。将符合AKI诊断标准的脓毒症患者101例作为SA-AKI组,其余50例脓毒症患者为非SA-AKI组。记录在液体复苏后,患者的毛细血管再灌注时间(CRT)和外周灌注指数(PI),以评估外周灌注,CRT≥3 s或PI<1.4判断为外周低灌注。比较SA-AKI组和非SA-AKI组外周低灌注的发生率,并分析SA-AKI患者外周低灌注与随访28 d病死率的相关性。结果与非SA-AKI组相比,SA-AKI组患者外周低灌注发生率明显更高,差异有统计学意义(P<0.05)。与存活组同一时间点比较,死亡组液体复苏后24 h时、48 h时、72 h时的PI值明显更低(P<0.05),PI和CRT评估的外周低灌注发生率明显更高(P<0.05)。多因素Cox回归分析结果显示,PI和CRT评估的外周低灌注是SA-AKI患者28 d死亡风险的独立影响因素(P<0.05)。随访28 d期间,外周低灌注患者生存率更低,中位生存期更短(P<0.001)。经Spearman秩相关性分析显示,SA-AKI患者PI值与24 h累积液体平衡呈显著负相关(r=-0.248,P=0.017)。结论SA-AKI患者的外周低灌注发生率明显升高,且外周低灌注与SA-AKI患者随访28 d死亡风险增加有关。液体平衡可能是SA-AKI患者外周低灌注发展和预后相关的因素。Objective To investigate the relationship between peripheral hypoperfusion and mortality in patients with sepsis associated acute kidney injury(SA-AKI).Methods A retrospective analysis was conducted to select 151 sepsis patients who were admitted to the Intensive Care Department of the Second Affiliated Hospital of Xi'an Jiaotong University from March 2020 to December 2023 as the study subjects.A total of 101 patients with sepsis who met the diagnostic criteria for AKI were included in the SA-AKI group,and the other 50 patients with sepsis were included in the non-SA-AKI group.Peripheral perfusion was assessed using capillary reperfusion time(CRT)and peripheral perfusion index(PI)after fluid resuscitation,with CRT≥3 s or PI<1.4 being considered peripheral hypoperfusion.The incidence of peripheral hypoperfusion was compared between the SAAKI group and the non-SA-AKI group,and the association between peripheral hypoperfusion and 28 days mortality in SA-AKI patients was analyzed.Results Compared with non-SA-AKI group,the incidence of peripheral hypoperfusion in SA-AKI group was significantly higher,and the difference was statistically significant(P<0.05).Compared with the survival group at the same time point,the PI values at 24 hours,48 hours and 72 hours after fluid resuscitation in the death group were significantly lower(P<0.05),and the incidence of peripheral hypoperfusion assessed by PI and CRT was significantly higher(P<0.05).Multivariate Cox regression analysis showed that peripheral hypoperfusion assessed by PI and CRT was an independent factor for 28 days mortality risk in SA-AKI patients(P<0.05).During the 28 days follow-up,patients with peripheral hypoperfusion had lower survival and shorter median survival(P<0.001).Spearman rank correlation analysis showed that PI was significantly negatively correlated with 24 hours accumulated fluid balance in SA-AKI patients(r=-0.248,P=0.017).Conclusion The incidence of peripheral hypoperfusion was significantly increased in SA-AKI patients,and peripheral hypoperfu

关 键 词：脓毒症相关急性肾损伤 外周低灌注 病死率 液体平衡 

分 类 号：R459.7[医药卫生—急诊医学]