脓毒症休克患者肾阻力指数的影响因素分析

Analysis of the influencing factors of renal resistive index in patients with septic shock

目的分析影响脓毒症休克患者肾阻力指数(RRI)的因素。方法前瞻性观察研究,选取该院重症医学科2017年11月至2018年10月连续收治的脓毒症休克患者117例,以RRI值是否≥0.74分为高RRI组(RRI值≥0.74)和低RRI组(RRI值<0.74),比较两组患者的性别、年龄、基础疾病、感染部位、急性生理和慢性健康状况评分Ⅱ(APACHEⅡ评分)、序贯器官功能衰竭评分(SOFA)、血流动力学指标[心率、收缩压、舒张压、平均动脉压(MAP)、中心静脉压、心脏指数]、去甲肾上腺素用量及实验室指标,发生急性肾损伤(AKI)的比例、需肾脏替代治疗(RRT)的比例、重症监护室(ICU)住院时间、ICU死亡率、28 d死亡率等。采用logistic回归分析确定脓毒症休克患者RRI的影响因素。结果剔除10例患者,最终纳入107例,其中高RRI组42例,低RRI组65例。两组年龄、高血压患者百分比、APACHEⅡ评分、SOFA、舒张压、MAP、ICU死亡率、28 d死亡率有明显差异(P<0.05)。单因素logistic回归分析发现,年龄、高血压、APACHEⅡ评分、SOFA、舒张压、MAP与RRI有关。将以上因素纳入多因素logistic回归分析,结果显示,年龄[OR=1.068,95%CI(1.024,1.113),P=0.002]、MAP[OR=0.932,95%CI(0.879,0.988),P=0.043]为脓毒症休克患者RRI的影响因素。结论年龄、MAP为脓毒症休克患者RRI的影响因素。

Objective To explore the factors impacting renal resistive index(RRI)in patients with septic shock.Methods A total of 117 patients with septic shock in the intensive care unit(ICU)of this hospital were continuously included in the prospective observational study from November 2017 to October 2018.Based on whether the value of RRI was equal to or greater than 0.74,the patients were divided into the high RRI group(patients with an RRI≥0.74)and the low RRI group(patients with an RRI<0.74).A comparison of sex,age,baseline diseases,infection sites,acute physiology and chronic health evaluationsⅡscore(APACHEⅡscore),sequential organ failure assessment score(SOFA score),hemodynamic parameters[heart rate,systolic pressure,diastolic pressure,mean arterial pressure(MAP),central venous pressure,cardiac index],the dosage of norepinephrine and laboratory indicators,percentage of cases with acute kidney injury(AKI),percentage of cases requiring renal replacement therapy(RRT),length of ICU stay,ICU mortality,28-day mortality between the two groups were compared.A logistic regression analysis was used to determine the factors influencing RRI in patients with septic shock.Results Ten patients were excluded from the study.And a total of 107 patients were eventually included,including 42 cases in the high RRI group and 65 cases in the low RRI group.There were statistically significant differences in patients′age,percentage of patients with hypertension,APACHEⅡscore,SOFA score,diastolic pressure,MAP,ICU mortality and 28-day mortality between the two groups(P<0.05).The results of univariate logistic regression analysis showed that RRI was significantly correlated with patients′age,hypertension,APACHEⅡscore,SOFA score,diastolic pressure and MAP(P<0.05).After including the above variables in multivariate logistic regression analysis,the results found that patients′age[OR=1.068,95%CI(1.024,1.113),P=0.002]and MAP[OR=0.932,95%CI(0.879,0.988),P=0.043]were independent factors of RRI in patients with septic shock.Conclusion Age and MAP are the influencing factors of RRI in patients with septic shock.