脓毒性休克合并急性肾损伤患儿的临床特征及影响因素分析

Clinical features and influencing factors of septic shock with acute kidney injury in PICU

目的:探讨脓毒性休克合并急性肾损伤(AKI)患儿的临床特征及影响因素。方法:回顾性分析昆明市儿童医院2018年1月—2019年12月期间入住重症监护病房(PICU)的脓毒性休克患儿142例,其中伴有AKI的患儿48例。将所收集的病例分为AKI组和非AKI组,对两组的临床资料进行统计学分析,得出脓毒性休克合并AKI患儿的临床特征、发生的独立危险因素。结果:PICU内脓毒性休克发生率为4.8%,脓毒性休克合并AKI的发生率为33.8%;非AKI组与AKI组年龄、中枢系统感染、合并心肌损伤、合并肝功能损伤、合并呼吸衰竭、合并脑功能障碍、脏器损伤总数、行机械通气治疗、行腹腔手术治疗、血管活性药物使用数量、血小板计数、PCT、尿素、乳酸等的比较,差异均有统计学意义。将单因素分析有统计学意义的指标纳入Logistic回归分析,结果显示机械通气、PCT、乳酸是脓毒性休克合并AKI发生的危险因素。结论:PICU中脓毒性休克合并AKI患儿的原发感染部位主要为呼吸系统;脓毒性休克合并AKI比未合并AKI的患儿易有中枢系统感染,易合并心肌损伤、肝功能损伤、呼吸衰竭、脑功能障碍,易有腹腔手术经历,需要进行呼吸机辅助通气治疗的患儿偏多,血管活性药物所需的使用数量相对偏多,常有更低的血小板、更高的尿素、乳酸和PCT;机械通气、PCT以及乳酸是脓毒性休克合并AKI发生的危险因素。

Objective: To investigate the clinical features an influencing factors of septic shock combined with acute kidney injury in children. Methods: One hundred and forty-two children with septic shock admitted to the intensive care unit(PICU) from January 2018 to December 2019 in Kunming Children’s Hospital that met the inclusion criteria were selected, including 48 children with AKI. The risk factors of septic shock with AKI and the clinical basic information such as age, sex, infection site and pathogenic microorganism were recorded. The collected cases were divided into AKI group and non-AKI group. The single factor statistical analysis and multi-factor statistical analysis were carried out for each factor in each group. The clinical characteristics and independent risk factors indicating AKI severity of septic shock were obtained. Results: The incidence of septic shock in PICU was 4.8%, and the incidence of septic shock complicated with AKI was 33.8%. There were significant differences between non-AKI group and AKI group in age, central system infection with myocardial injury, liver function injury, respiratory failure, brain dysfunction, total number of organ injuries, mechanical ventilation, abdominal surgery, usage of vasoactive drugs, platelet count, PCT, urea and lactic acid. The Logistic regression analysis showed that mechanical ventilation, PCT and lactic acid were the risk factors of septic shock complicated with AKI. Conclusion: The primary infection site of septic shock combined with AKI in PICU is mainly respiratory system. Children with septic shock complicated with AKI are more prone to central system infection, myocardial injury, liver function injury, respiratory failure and brain dysfunction than those without AKI, and are more likely to have abdominal surgery experience. More children need ventilator-assisted ventilation treatment, and the use of vasoactive drugs is relatively large, often with lower platelets and higher urea, lactic acid and PCT;Mechanical ventilation, PCT and lactic acid are the risk factors of septic shock complicated with AKI.