摘要
目的分析ICU感染性休克患者伴急性肾损伤(acute kidney injury,AKI)发生及预后的影响因素。方法选取2015年4月至2017年4月本院ICU收治的90例感染性休克患者为研究对象,依据是否发生感染将其中不伴AKI的45例患者纳入对照组,伴AKI的45例患者纳入观察组,根据患者预后情况,将观察组患者又分为死亡组(10例)和存活组(35例)。统计患者年龄、性别、体质指数(body mass index,BMI)、饮酒史、吸烟史、高血压病史、糖尿病病史、血管紧张素转化酶抑制剂(angiotensin converting enzyme inhibitor,ACEI)使用情况、使用升压药物种类、输血史、机械通气、造影剂使用情况、心率、呼吸频率、肾小球滤过率(glomerular filtration rate,GFR)、急性生理与慢性健康状况评分系统Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)评分、血红蛋白、白细胞计数、血小板计数、白蛋白、血尿素氮、C反应蛋白水平及血p H等临床资料;记录观察组患者生存情况并进行分析。结果观察组和对照组患者使用2种以上升压药物、输血史、应用造影剂占比、GFR、APACHEⅡ评分、血小板计数、血尿素氮、血p H、C反应蛋白水平比较差异均具有显著性(P_均<0.05);其中输血史、GFR <50 ml/min、APACHEⅡ评分> 80分为ICU感染性休克伴AKI的独立危险因素。存活组与死亡组患者高血压病史、糖尿病病史、应用ACEI药物、使用2种以上升压药物、使用机械通气患者占比及GFR、血p H、白蛋白、C反应蛋白水平比较差异均具有显著性(P_均<0.05);其中使用2种以上升压药物、使用机械通气、白蛋白<30 g/L为影响ICU感染性休克伴AKI预后的独立危险因素。结论输血史、GFR <50 ml/min、APACHEⅡ评分> 80分为ICU感染性休克患者发生AKI的独立危险因素,使用2种以上升压药物、使用机械通气、白蛋白<30 g/L为影响ICU感染性休克伴AKI患者预后的独立危险因素。
Objective To analyze the influencing factors of occurrence and prognosis of acute kidney injury(AKI)in patients with septic shock in ICU.Method From April 2015 to April 2017,90 patients with septic shock in our hospital were divided into control group(45 cases with AKI)and observation group(45 cases without AKI)according to whether they were affected with AKI,and patients in observation group were divided into death group(10 cases)and survival group(35 cases)according to their prognosis.The clinical data such as age,gender,body mass index,drinking history,smoking history,hypertension history,diabetes mellitus history,use of angiotensin converting enzyme inhibitor(ACEI),types of pressor agents,history of blood transfusion,mechanical ventilation,contrast agent,heart rate,respiratory rate,glomerular filtration rate(GFR),acute physiology and chronic health assessmentⅡ(APACHEⅡ),hemoglobin,white blood cell count,platelet count,albumin,blood urea nitrogen,blood pH,C-reactive protein were recorded,and the prognosis of patients in observation group were analyzed.Result There were significant difference between observation group and control group in the proportion of usage of more than two kinds of pressor agents,blood transfusion history and contrast agents,GFR,APACHEⅡscores,platelets count,blood urea nitrogen,blood pH and C-reactive protein levels between the two groups(Pall<0.05).Among them,blood transfusion history,GFR<50 ml/min,APACHEⅡscores>80 points were independent risk factors of septic shock with AKI in ICU.There were significant differences in the proportion of hypertension history,diabetes mellitus history,usage of ACEI,usage of more than two kinds of pressor agents and mechanical ventilation and GFR,albumin,blood pH and C-reactive protein levels between the two groups(Pall<0.05).Among them,the usage of more than two kinds of antihypertensive agents,mechanical ventilation and albumin<30 g/L were independent risk factors of the prognosis of septic shock with AKI in ICU.Conclusion Blood transfusion history,GFR<50 ml/min,APACHEⅡscores>80 points are independent risk factors of patients with septic shock combined with AKI in ICU.The usage of more than two kinds of pressor agents,mechanical ventilation,albumin<30 g/L are independent risk factors of the prognosis of patients with septic shock combined with AKI in ICU.
作者
李荣
赵荣
谢秀华
LI Rong;ZHAO Rong;XIE Xiu-hua(Intensive Care Unit,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China)
出处
《中国医学前沿杂志（电子版）》
2018年第10期147-150,共4页
Chinese Journal of the Frontiers of Medical Science(Electronic Version)
关键词
感染性休克
急性肾损伤
影响因素
预后
Septic shock
Acute renal injury
Influencing factor
Prognosis
