ICU急性肾损伤患者458例预后影响因素分析

Analysis on influencing factors of prognosis in 458 ICU patients with acute kidney injury

目的:探讨影响重症加强治疗病房(ICU)急性肾损伤(AKI)患者预后的相关因素。方法:回顾性分析458例AKI患者的临床资料,其中死亡患者279例,存活患者179例,存活组、死亡组分别作为因变量,性别、年龄、入ICU原因、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)、机械通气原因、机械通气时间、是否成功撤机、是否发生ICU院内感染、是否行连续性血液净化(CBP)、是否有脓毒性休克、是否行有创血液动力学监测、是否输血、住ICU时间分别作为自变量,先分别对自变量作单因素分析,再用有意义的自变量对因变量做Logistic回归分析。结果:影响死亡与否的自变量有:成功撤机、ICU院内感染、脓毒性休克、血液动力学监测、输血、机械通气原因、APACHEⅡ评分。Logistic回归分析得出,成功撤机、脓毒性休克对死亡或存活的因变量有影响,其中是否成功撤机,回归系数为-3.369,Wald值为105.169,P=0.000,Exp(B)为0.034;是否脓毒性休克,回归系数为1.181,Wald值为12.305,P=0.000,Exp(B)为3.257。结论:影响ICU急性肾损伤患者预后的相关因素较多,是否成功撤机、是否发生脓毒性休克是影响ICUAKI患者预后的独立危险因素。

Objective: To explore the factors influencing the prognosis of patients with acute kidney injury (AKI) in intensive care unit (ICU). Methods: 458 cases of AKI were analyzed retrospectively. Among them, 279 patients died and 179 survived. Survival and death groups were treated as dependent variable, and gender, age, reason of ICU admission, acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) score, mechanical ventilation reason, length of mechanical ventilation, successful weaning, nosocomial infection, continuous blood purification (CBP), septic shock, hemodynamic monitoring, blood transfusion and length of ICU stay were used as the independent variables. First, the independent variables were analyzed by single factor analysis. Second, the independent variables influencing the dependent variables were analyzed by Logistic regression analysis. Results: The independent variables that influenced the death were as follows: successful weaning, nosocomial infection, septic shock, hemodynamic monitoring, blood transfusion, mechanical ventilation reason and APACHE Ⅱ score. Logistic regression analysis of the relevant factors revealed that the two independent variables of successful weaning and septic shock had an effect on the dependent variables of death or survival. Regression coefficient of successful weaning was -3.369, the Wald value was 105.169, P =0.000, Exp ( B ) was 0.034. Regression coefficient of septic shock was 1.181, the Wald value was 12.305, P =0.000, Exp (B) was 3.257. Conclusion: Many factors influence the prognosis of ICU AKI patients. The success of weaning and the occurrence of septic shock are independent risk factors for the prognosis of ICU AKI patients.