影响脓毒症相关急性肾损伤患者接受连续性肾脏替代治疗的相关因素分析

Analysis of factors related to continuous renal replacement therapy in patients with sepsis related acute kidney injury

目的分析探讨影响脓毒症相关急性肾损伤(acute kidney injury,AKI)患者接受连续性肾脏替代治疗(continuousrenal replacement therapy,CRRT)的相关因素。方法选取我院于2017年6月—2018年12月间收治的278例脓毒症相关AKI患者为研究对象,根据患者是否选择接受CRRT将所有患者分为甲、乙2组,其中甲组为采取CRRT的患者,乙组则均为不接受CRRT的患者。记录2组患者的临床脏器功能评分和疾病严重程度评分,比较2组患者的一般资料及实验室检查结果,对影响患者接受CRRT的相关危险因素进行Logistic回归分析。结果甲组患者的贫血程度重于乙组患者,凝血功能及肾功能均显著差于乙组患者,B型钠尿肽和乳酸水平均显著高于乙组患者(P均<0.05)。甲组患者的疾病严重程度重于肾脏、肝脏、肺脏损伤率等均显著高于乙组患者(P均<0.05)。Logistic回归分析结果显示,氧分压、二氧化碳分压、血清肌酐水平、急性生理与慢性健康评分、ICU住院时间等因素均是影响患者接受CRRT的相关危险因素。结论氧分压、二氧化碳分压、血清肌酐水平、急性生理与慢性健康评分、ICU住院时间等均是影响脓毒症相关AKI患者接受CRRT的相关因素,具有较高的临床指导价值。

Objective To analyze the factors influencing the acceptance of continuous renal replacement therapy(CRRT)in septic related acute kidney injury(AKI)patients.Methods From June 2017 to December 2018,278 patients with septic related AKI admitted in our hospital were included in this study.All the patients were divided into 2 groups(A and B)according to their acceptance of CRRT.The patients in group A received CRRT while those in group B didn’t receive CRRT.Clinical visceral function score and disease severity score of patients in the 2 groups were recorded.General data and laboratory test results of patients in the 2 groups were compared.Logistic regression analysis was conducted on the risk factors related to the acceptance of CRRT in patients.Results The anemia degree,coagulation function and renal function of patients in group A were significantly worse than those of patients in group B,and the levels of N-terminal pro-B-type natriuretic peptide(NT-proBNP)and lactic acid of patients in group A were significantly higher than those of patients in group B(P<0.05).The severity of disease and the rate of kidney,liver and lung injury in group A were significantly higher than those in group B(P<0.05).Logistic regression analysis showed that partial pressure of oxygen,partial pressure of carbon dioxide,serum creatinine level,APACHEⅡscore and ICU length of stay were the risk factors influencing the patients receiving CRRT.Conclusions Partial pressure of oxygen,partial pressure of carbon dioxide,serum creatinine level,APACHEⅡscore,and ICU length of stay are the risk factors affecting the acceptance of CRRT in patients with septic related AKI,and have great clinical guidance value.