早期外周灌注指数和脓毒症相关急性肾损伤的相关性研究

Correlation between early peripheral perfusion index and sepsis associated acute kidney injury

目的 探讨早期外周灌注指数(PPI)与脓毒症相关急性肾损伤(SA-AKI)的相关性。方法 回顾性纳入脓毒症患者303例,收集其一般资料及临床资料、血流动力学指标及入ICU 24 h内的动脉血乳酸水平。根据有无SA-AKI将所有患者分为SA-AKI组(52例)和非SA-AKI组(251例),根据外周异常灌注情况将303例患者分为PPI异常组(PPI<1.4,160例)及PPI正常组(PPI≥1.4,143例)。采用多元logistic回归分析探讨SA-AKI发生的独立危险因素。结果 SA-AKI组入ICU基线序贯器官衰竭(SOFA)评分、机械通气(MV)时间、ICU入住时间、心率(HR)、死亡及PPI<1.4患者比例均高于非SA-AKI组,入ICU 24 h内尿量及PPI均低于非SA-AKI组(P<0.05)。PPI异常组乳酸水平、HR、SA-AKI及死亡患者比例均显著高于PPI正常组,平均动脉压(MAP)显著低于PPI正常组(P<0.05)。多元logistic回归分析结果显示,入ICU基线SOFA评分、HR和PPI<1.4均为脓毒症患者发生SA-AKI的独立危险因素,入ICU 24 h内尿量为脓毒症患者发生SA-AKI的独立保护因素(P<0.05)。结论 早期PPI<1.4是发生脓毒症患者发生SA-AKI的独立危险因素,和PPI正常的脓毒症患者相比,PPI异常患者SA-AKI的发生率显著增加。

Objective To investigate the correlation between early peripheral perfusion index(PPI) and sepsis associated acute kidney injury(SA-AKI).Methods A total of 303 patients were retrospectively included.General data and clinical data,hemodynamic indexes and arterial blood lactate levels within 24 h after admission to ICU.All patients were divided into SA-AKI group(52 cases) and non-SA-AKI group(251 cases) according to the presence or absence of SA-AKI,and divided into abnormal PPI group(160 cases) and normal PPI group(143 cases) according to abnormal peripheral perfusion.Multiple logistic regression analysis was used to investigate the independent risk factors of SA-AKI.Results The baseline sequential organ failure assessment(SOFA) score,mechanical ventilation(MV) time,ICU stay time,heart rate(HR),mortality and proportion of patients with PPI<1.4 in SA-AKI group were higher than those in non-SA-AKI group,and the urine volume and PPI within 24 h of ICU admission were lower than those in non-SA-AKI group(P<0.05).The lactate level,HR,proportion of patients with SA-AKI and died in abnormal PPI group were significantly higher than those in normal PPI group,and the mean arterial pressure(MAP) was significantly lower than that in normal PPI group(P<0.05).Multivariate logistic regression analysis showed that baseline SOFA score,HR and PPI<1.4 were independent risk factors for SA-AKI in sepsis patients,urine volume within 24 h of ICU admission was independent protective factor for SA-AKI in sepsis patients(P<0.05).Conclusion Early PPI<1.4 is an independent risk factor for SA-AKI in patients with sepsis.Compared with sepsis patients with normal PPI,the incidence of SA-AKI in patients with abnormal PPI is significantly increased.