脓毒性休克并发急性肾损伤危险因素分析

Risk factors for septic shock complicated with acute renal injury

目的分析脓毒性休克患者并发急性肾损伤(AKI)的危险因素。方法 154例脓毒性休克患者按照是否并发AKI分为AKI组(114例)和非AKI组(40例),采用单因素分析法、多因素Logistic回归分析法分析脓毒性休克患者并发AKI的影响因素和危险因素。结果两组年龄、BMI、脓毒症相关器官衰竭估计评分(SOFA评分)、慢性健康状况评估Ⅱ评分、血乳酸水平、复苏后6 h平均动脉压、复苏后6 h心率、复苏后6 h每小时尿量、复苏后6 h去甲肾上腺素剂量、复苏前外周灌注指数(PPI)、复苏后6 h PPI、外周灌注指数变化值(ΔPPI)、24 h液体平衡、血培养阳性率、28 d病死率比较,P均<0.05。多因素分析显示,SOFA评分是脓毒性休克患者并发AKI的危险因素,ΔPPI水平升高是脓毒性休克患者并发AKI的保护因素,P均<0.05。结论脓毒性休克患者并发AKI的危险因素是SOFA评分,保护因素是ΔPPI水平升高。

Objective To analyze the risk factors for septic shock complicated with acute renal injury(AKI).Methods Totally 154 patients with septic shock were divided into AKI group(114 cases) and non-AKI group(40 cases) according to whether they were accompanied by AKI.Univariate analysis and multivariate Logistic regression analysis were used to analyze the influencing factors and risk factors for septic shock complicated with AKI.Results Significant differences were found in age,BMI,sepsis-related organ failure assessment score(SOFA score),chronic health evaluation Ⅱ score,serum lactate level,mean arterial pressure at 6 h after resuscitation,heart rate at 6 h after resuscitation,urine output per hour at 6 h after resuscitation,the dose of norepinephrine at 6 hour after resuscitation,peripheral perfusion index(PPI) at the beginning resuscitation,PPI at 6 hour after resuscitation,the changes of peripheral perfusion index(ΔPPI),24-hour fluid balance,the positive rate of blood culture,and 28-day mortality between the two groups(all P<0.05).Multivariate analysis showed that SOFA score was independent risk factor for septic shock complicated with AKI,and the elevated ΔPPI level was independent protective factor for septic shock complicated with AKI(both P<0.05).Conclusion SOFA score is independent risk factor for septic shock complicated with AKI,while the elevated ΔPPI level is independent protective factor.