脓毒症合并急性肾损伤患者的临床特点与预后

Clinical characteristics and prognosis in patients with septic and acute kidney injury

目的：研究脓毒症合并急性肾损伤（AKI）患者的临床特点与预后。方法：收集我院2008年1月～2011年6月收治的124例脓毒症合并AKI患者的临床资料，同期非脓毒症合并AKI患者280例作为对照组，分析脓毒症合并AKI组患者的临床特点及预后。结果：脓毒症合并AKI患者中，感染部位主要为肺部（50．0％）和腹部（29．0％）。脓毒症与非脓毒症AKI患者相比，两者的APACHEll评分、平均动脉压，机械通气、血管活性药物应用的比例，器官衰竭数≥3个者等指标的比较差异有统计学意义（P〈0．05）。RIFLE不同分级中脓毒症合并AKI患者的病死率分别是R组60．0％、I组66．7％、F组73．5％，较非脓毒症组比较差异有统计学意义（P〈0．05）。非脓毒症与脓毒症AKI患者的总住院病死率分别为37．8％、68．5％，差异有统计学意义（P〈0．01）。结论：脓毒症AKI患者与非脓毒症AKI患者相比，临床各项指标更差，有更高的临床病死率。

Objective. To investigate the clinical characteristics and prognosis in patients with acute kidney injury （AKI） due to sepsis. Methods, A case-control retrospective study was carried out in AKI pa tients with/without sepsis from January 2008 to June 2011. Clinical characteristics and prognosis in pa- tients with septic AKI were analyzed. Results- The most common site of infection for AKI patients with sepsis were lungs （50.0%）and abdomen （29.0%）. Patients with sepsis had significantly higher APACHE II scores, higher rates of mechanical ventilation, organ failure≥3 and lower mean artery pressure than pa- tients without sepsis. Based on RIFLE criteria, the mortality rate was 60.0%for R group, 66. 7% for I group and 73.5%for F group in patients with sepsis which were much higher than in patients without sep- sis. AKI patients with sepsis also has higher total mortality rate （68.50/00 vs. 37.8%,P〈0.01）. Oonclu- tion.. Compared with the patients without sepsis, patients with sepsis have worse clinical parameters and a higher inhospital mortality.