EICU脓毒症患者出现急性肾损伤的原因分析

Causes analysis of acute kidney injury in patients with sepsis in EICU

目的探讨急诊重症监护室(EICU)脓毒症患者出现急性肾损伤(AKI)的影响因素。方法选取2012年1月~2014年3月青海大学附属医院EICU收治的102例脓毒症患者为研究对象,按照有无出现AKI将其分为两组,脓毒症组(未出现AKI,66例)和脓毒症并发AKI组(36例),比较两组临床资料,采用单因素和多元回归分析法探讨EICU脓毒症合并AKI的独立危险因素。结果 AKI发生率为35.29%(36/102)。单因素分析显示,脓毒症并发AKI组与脓毒症组在高血压史、平均动脉压(MAP)评分、APACHEⅡ评分、24 h尿量、血肌酐(Scr)评分、24 h液体净入量评分、氧合指数、血尿素氮(BUN)、动脉血乳酸评分、血清肌红蛋白(MYO)方面比较,差异有统计学意义(P<0.05)。多元Logistic回归分析显示,入住EICU时MAP评分高(OR=2.136,P=0.007,95%CI:1.115~3.898)、APACHEⅡ评分高(OR=2.058,P=0.004,95%CI:1.011~3.458)、Scr评分高(OR=2.210,P=0.005,95%CI:1.019~3.998)、动脉血乳酸评分高(OR=2.368,P=0.003,95%CI:1.128~3.987)和MYO高水平(OR=2.587,P=0.002,95%CI:1.127~4.027)是脓毒症EICU患者出现AKI的独立危险因素(P<0.05)。结论入住EICU时MAP、A PACHEⅡ、Scr、动脉血乳酸评分和MYO水平越高,脓毒症患者并发AKI的风险越大,建议据此为EICU患者制订合理防治措施。

Objective To investigate the influencing factors of acute kidney injury （AKI） in patients with sepsis in the emergency intensive care unit （EICU）. Methods From January 2012 to March 2014, a total of 102 patients with sepsis admitted to EICU in the Affiliated Hospital of Qinghai University were selected as the research subjects and divided into sepsis groups （without AKI 66 cases） and sepsis with AKI group （36 cases） according to the presence of AKI. The clinical data of the patients were compared between the two groups. The independent risk factors of AKI in patients with sepsis in EICU were analyzed by univariate and multivariate analysis. Results The incidence of AKI was 35.29% （36/102）. Univafiate analysis showed that there were significant differences in the history of hypertension, mean arterial pressure （MAP）, APACHE 11,24 h urine, Ser, the score of 24 h net fluid input, oxygenation index, urea nitrogen （BUN）, arterial lactate score and serum myoglobin （MYO） between the two groups （P 〈 0.05）. Multivariate Logistic regression analysis showed that high MAP score（OR = 2.136, P = 0.007, 95%CI： 1.115-3.898）, high APACHE score （OR = 2.058, P = 0.004, 95%CI：1.011-3.458）, high Ser score（OR = 2.210, P = 0.005, 95%CI： 1.019-3.998）, high arterial blood lactate score （OR=2.368, P=0.003, 95%CI：1.128-3.987） and high MYO level （OR = 2.587, P = 0.002, 95%CI：I.127-4.027） were independent risk factors of AKI in patients with sepsis on admission to EICU （P 〈 0.05）. Conclusion The higher scores of MAP, APACHE Ⅱ, Set, arterial lactate and MYO level are, the higher the risk of AKI in patients with sepsis is. Therefore, it is suggested that the reasonable prevention and treatment measures should be taken for patients in EICU.