感染性休克患者发生AKI的危险因素分析

Analysis of the risk factors of AKI in patients with septic shock

目的分析感染性休克患者发生急性肾损伤(AKI)的危险因素,为临床预防AKI的发生提供理论依据。方法随机选取2014年8月至2017年8月该院重症监护病房(ICU)收治的98例感染性休克患者作为研究对象,并依据是否发生AKI及AKI分级标准分为未发生AKI(NAKI)组、AKI 1级组、AKI 2级组、AKI 3级组共4组,对比分析各组间相关指标的变化。结果感染性休克患者中AKI的发生率为63.3%。AKI 1~3级各组ICU住院时间、急性生理学及慢性健康状况评分量表(APACHEⅡ)评分、器官衰竭个数、机械通气占比均显著高于NAKI组,差异均有统计学意义(P<0.05),且随着AKI分级增加各指标水平均逐渐增加,AKI 3级组以上各指标显著高于AKI 2级组和AKI 1级组,差异均有统计学意义(P<0.05);AKI 3级组和AKI 2级组血清CRP水平均显著高于AKI 1级组和NAKI组,差异均有统计学意义(P<0.05);AKI 1~3级各组6 h补液量均显著高于NAKI组,差异均有统计学意义(P<0.05)。多因素logis-tic回归分析显示,APATHEⅡ评分、器官衰竭个数、应用机械通气是影响感染性休克患者发生AKI的独立危险因素(P<0.05),其风险比值分别为1.576、1.863、1.176。结论 AKI是感染性休克的常见并发症。ICU住院时间、APACHEⅡ评分、器官衰竭个数、应用机械通气、炎症指标和6 h补液量等与AKI的发生密切相关,其中APATHEⅡ评分、器官衰竭个数、应用机械通气是感染性休克患者发生AKI的独立危险因素。在临床治疗中应密切监测、及时干预,以降低AKI的发生率,改善患者预后。

Objective To explore the risk factors of AKI in patients with septic shock, and provide theoretical basis for the occurrence of AKI. Methods Randomly selected 98 patients admitted to the hospital ICU patients with septic shock from August 2014 to August 2017as the research object.And according to whether AKI and AKI classification standard, the patients were divided into fota＂ groups：no AKI （NAKI） group, AKI grade 1 group, AKI grade 2 group and AKI grade 3 group, the change of the comparative analysis among the groups of related indicators. Results The incidence of AKI in septic shock was 63.3%. The ICU hospitalization days, APACHE Ⅱ score, the number of organ faiha＇e and mechanical ventilation in all of the AKI classi- fication groups were significantly higher than that of NAKI group, the differences were statistically significant （P〈0.05）.And as the AKI classification increases, each indexes increases gradually, the above indexes of AKI 3 group were significantly higher than those of AKI 1 and 2 group, the differences were statistically significant （P〈0.05）.Serum CRP levels in AKI 3 and AKI 2 groups were significantly higher than those in AKI 1 and NAKI groups, the difl＇erences were statistically significant （P〈0.05）. The amount of 6 h replenishment in all AKI classification groups was significantly higher than that in NAKI group, the differ- ences were statistically significant （P〈0.05）. Multiple logistic regression analysis showed that APATHE Ⅱ score, the number of organ failure and mechanical ventilation were independent risk factors for the occurrence of AKI in patients with septic shock （P〈0.05） , the risk ratio were 1.576,1.863,1.176, respectively. Conclusion AKI is a common complication of septic shock. ICU hospitalization days, APACHE Ⅱ score, number of organ failure, application of mechanical ventilation, imqammation, indicators and 6 hours rehydration fluids are closely related to the occmTence of AKI, among them, the APATHE Ⅱ score, number of organ faiha＇e, application of mechanical ventilation are independent risk factors for AKI in patients with septic shock. The clinical treatment shall be closely monitored and timely intervention, to reduce the incidence of AKI, improve the prognosis of patients.