肾动脉阻力指数对老年脓毒症急性肾损伤患者优化治疗及预后的预测价值

The value of renal resistive index in optimal treatment and prognosis prediction for elderly patients with septic acute kidney injury

目的探讨肾动脉阻力指数(RRI)在老年脓毒症急性肾损伤(SAKI)患者优化治疗及预后预测价值。方法2018年1月至2019年6月入住重症医学科(ICU)的68例老年SAKI患者入选本研究,按急性肾损伤(AKI)分期标准分为AKI 1~3期组,另选择12例老年脓毒症无AKI患者为AKI 0期组。入院后按脓毒症集束化治疗,比较4组患者组间一般情况及入ICU 24 h时RRI、急性生理与慢性健康评分Ⅱ(APACHEⅡ)评分、24 h补液量、血乳酸(Lac)、连续性肾脏替代治疗(CRRT)比例及28 d病死率等临床数据。采用多元logistic回归分析28 d死亡危险因素。结果4组间比较,ICU住院时间、RRI、序贯器官衰竭估计(SOFA)评分、24 h补液量、氧合指数差异均有统计学意义(均P<0.05)。与AKI 0~2期组相比,AKI 3期组28 d病死率、CRRT比例、Lac、APACHE II评分及中心静脉压(CVP)均显著升高(均P<0.05)。Spearman相关性分析表明,RRI与血清肌酐(SCr)值、24 h补液量、CVP均呈相关性(均P<0.05)。28 d存活者共53例,与肾功能未恢复者相比,肾功能恢复者RRI显著降低,CRRT比例显著提高(均P<0.05)。多元logistic回归分析提示RRI及APACHE II评分是老年SAKI患者28 d死亡独立危险因素(均P<0.05),RRI预测28 d死亡的曲线下面积(AUC)为0.84(P<0.05),截点为0.76。结论对老年SAKI患者,RRI值高于0.76时提示预后差,建议限制性补液,有条件尽早启动CRRT。

Objective To explore the value of renal resistive index(RRI)in optimal treatment and prognosis prediction for elderly patients with septic acute kidney injury(SAKI).Methods A total of 68 elderly patients with SAKI in intensive care unit(ICU)of our hospital from January 2018 to June 2019 were enrolled in the study.They were divided into acute kidney injury(AKI)stage 1-3 groups according to AKI stage standard,and 12 cases of elderly septic patients without AKI were enrolled as AKI stage 0 group.All the patients were treated with sepsis bundle.The general situation and clinical data such as RRI,APACHEⅡscore,24 hour fluid supply,lactate,CRRT ratio,and 28 day mortality were compared among the four groups.Multiple logistic regression analysis was used to analyze the risk factors of 28 day death.Results There were statistically significant differences in ICU hospitalization time,RRI,SOFA score,24 hour fluid supply,and oxygenation index among the four groups(all P<0.05).The 28 day mortality,CRRT ratio,lactate value,APACHE II score,and central venous pressure(CVP)in AKI stage 3 group were significantly higher than those in AKI stage 0-2 groups(all P<0.05).Spearman correlation analysis showed that RRI was correlated with SCr value,24 hour fluid supply,and CVP(all P<0.05).In 53 patients of the survival group,the RRI value was significantly lower and the proportion of CRRT was significantly higher in patients with renal function recovery(all P<0.05).Multiple logistic regression analysis indicated that RRI and APACHE II score were independent risk factors of 28 day death(all P<0.05).The area under curve(AUC)of RRI was 0.84(P<0.05)and the cutoff value was 0.76.Conclusion For elderly patients with SAKI,it suggests poor prognosis and CRRT should be started as early as possible when RRI is higher than 0.76.