早期生理盐水复苏后脓毒症患者血清氯水平 与急性肾损伤的关系

Relationship between serum chloride level and acute kidney injury in patients with sepsis after early saline resuscit

摘要:

目的 探索脓毒症患者经生理盐水复苏72 h 后血清氯离子水平与急性肾损伤（AKI）的关系。 方法 选取2015 年1 月—2019 年5 月山西医科大学第一医院重症监护室收治并用生理盐水早期复苏的200 例 脓毒症或脓毒症休克患者，按照72 h 后的血清氯，分为高氯血症组（≥ 110 mmol/L）和非高氯血症组 （<110 mmol/L），观察其初始血清氯离子浓度及肌酐、72 h 后最高血清氯离子浓度及肌酐、基础肌酐清除率 （Ccr）、初始急性生理功能和慢性健康状况评估Ⅱ（APACHE Ⅱ）评分、机械通气、肾替代治疗等指标，并 计算72 h 后血清氯离子变化值。结果 两组患者年龄、性别、机械通气、肾替代治疗、Ccr、APACHE Ⅱ 评分、72 h 后最高血清氯离子浓度及72 h 后血清氯离子浓度变化值比较，差异有统计学意义（P <0.05）。高 氯血症组AKI 发病率较非高氯血症组高（P <0.05）。单因素Logistic 回归分析显示，72 h 后最高血清氯离子 浓度与AKI 有关（P <0.05）。72 h 后血清氯离子浓度变化值≥ 1.5 mmol/L 和72 h 后血清氯离子浓度变化 值≥ 5.5 mmol/L 与AKI 也有关（P <0.05）。多因素Logistic 回归分析显示，APACHE Ⅱ评分[Ol ^ R=2.451 （95% CI：1.961，2.880），P =0.000]、72 h 后最高血清氯离子浓度[Ol ^ R=2.023（95% CI：1.991，3.211），P =0.010] 和72h 后血清氯离子浓度变化值[Ol ^ R=3.211（95% CI ：2.347，3.630），P =0.006] 是AKI 发病的危险因素。 结论 脓毒症患者经生理盐水复苏72 h 后血清高氯离子与AKI 独立相关，且72 h 后血清氯离子浓度变化值、 APACHE Ⅱ评分也与AKI 有关。

Abstract:

Objective To explore the relationship between serum chloride level and acute kidney injury (AKI) in patients with sepsis and sepsis shock after 72 h of normal saline resuscitation. Methods Using a retrospective cohort study, 200 patients with sepsis, who were admitted to the intensive care unit of the First Hospital of Shanxi Medical University from January 2015 to May 2019, were resuscitated with normal saline at early stage and divided into high chloride group ( ≥ 110mmol/L) and non-high chloride group (< 110mmol/L), according to serum chlorine after 72 h. The initial serum chloridion and creatinine, the highest serum chloridion and creatinine after 72 h, basal creatinine clearance rate (Ccr), initial acute physiology and chronic health evaluation Ⅱ score (APACHE Ⅱ ), mechanical ventilation, renal replacement therapy and other indicators were observed and the changes of serum chloridion were calculated. Results After 72 h of resuscitation, the incidence of AKI in the high-chlorine group was 37.33% (28/75), which was higher than the non-high-chlorine group [16.00% (20/125)] (P < 0.05). There were significant differences in Age, sex, mechanical ventilation, renal replacement therapy, Ccr, APACHE Ⅱ score, the highest serum chloride concentration after 72 hours and the change of serum chloride concentration after 72 hours between two groups (P < 0.05); univariate Logistic regression analysis found that the highest serum chloridion after 72 h was related to AKI (P < 0.05). Serum chloridion change≥1.5 mmol/L and serum chloridion change≥5.5 mmol/L were related to AKI (P < 0.05). After multivariate Logestic regression analysis, it was found that APACHE Ⅱ score [Ol^R = 2.451 (95% CI: 1.961, 2.880), P = 0.000], the highest serum chloridion after 72 h [Ol^R = 2.023 (95% CI: 1.991, 3.211), P = 0.010] and serum chloridion change [Ol^R = 3.211 (95% CI: 2.347, 3.630), P = 0.006] were risk factors for AKI. Conclusions Serum high chloride was independently associated with AKI after 72 h of resuscitation in patients with sepsis, and serum chloridion change and APACHE Ⅱ scores were also related to AKI.