脓毒症患者发生肾损伤的相关因素分析

Related factors of kidney injury in patients with sepsis

目的探讨脓毒症患者发生急性肾损伤的相关因素,为其预防提供依据。方法选取收治的315例脓毒症患者作为研究对象,根据病程分为观察组(合并急性肾损伤)和对照组(未合并急性肾损伤)。调查并比较两组的基线资料、病程变化、实验室指标及评分,采用多因素Logistic回归分析筛选出患者发生急性肾损伤的危险因素。结果 315例脓毒症患者中共有151例发生急性肾损伤,发生率为47.9%。观察组的男性比例、年龄、高血压、合并休克的比例显著高于对照组(P<0.05)。观察组的白蛋白(Alb)、平均动脉压(MAP)、肾小球滤过率(GFR)等显著低于对照组,乳酸、凝血酶原时间(PT)、急性生理学与慢性健康状况评分系统(APACHEⅡ)评分、查尔森基础疾病权重指数(WIC)评分、序贯器官衰竭估计(SOFA)评分等显著高于对照组(P<0.05)。多因素Logistic回归分析结果表明年龄、MAP、GFR、WIC评分是患者发生急性肾损伤的独立影响因素(P<0.05)。结论年龄较大、基础MAP越小、GFR越低、WIC评分越高可显著增加脓毒症患者发生急性肾损伤的风险,建议据此进行积极的预防。

Objective To explore the related factors of acute kidney injury in patients with sepsis,so as to provide basis for its prevention. Methods Totally 315 patients were enrolled for the study and assigned into observation group( complicated with acute kidney injury) and the control group( complicated without acute kidney injury) according to the course. The general information,disease course,laboratory index and grading were compared between the two groups. Multiple logistic regression analysis was performed to screen out the risk factors of acute kidney injury. Results Of 315 patients with sepsis,151 cases( 47. 9%) developed acute kidney injury. Age,the proportion of male,hypertension and shock in the observation group were significantly higher than those in the control group( P < 0.05). Albumin( Alb),mean arterial pressure( MAP),glomerular filtration rate( GFR) in the observation group were significantly lower than those in the control group,while lactic acid,prothrombin time( PT),scores of acute physiology and chronic health evaluation( APACHEⅡ),Charlson's weighted index of comorbidities( WIC) and sequential organ failure estimation( SOFA) were significantly higher than those in the control group( P < 0. 05). Results of multiple logistic regression analysis showed that age,MAP,GFR,WIC score were independent related factors of acute kidney injury in patients( P < 0. 05). Conclusions Older age,smaller base MAP,lower GFR and higher WIC score could significantly increase the risk of acute kidney injury in patients with sepsis,which should be positively prevented.