感染性休克伴急性肾损伤的危险因素及其预后相关因素分析

Analysis of risk factors and prognostic factors of septic shock with acute renal injury

摘要:

探讨感染性休克伴急性肾损伤的危险因素及其预后相关因素。方法选取2012年1月1日-2015年12月31日该院收治的感染性休克伴急性肾损伤患者60 例作为观察组，感染性休克不伴急性肾损伤患者60 例作为对照组，观察组分为死亡组14 例和存活组46 例。收集患者的临床资料进行比较。结果单因素分析结果显示，观察组与对照组应用造影剂、输血史、升血压药≥2 种、肾小球滤过率、中心静脉压、急性生理学与慢性健康状况（APACHE Ⅱ）评分、血小板、血尿素氮、血pH值、C 反应蛋白比较，差异有统计学意义（p <0.05）；多因素分析结果显示，输血史[OR=5.431（95%CI：1.892，13.265）]、肾小球滤过率[OR=0.965（95%CI：0.784，0.985）]、APACHE Ⅱ评分[OR=3.896（95%CI：1.576，9.784）]为感染性休克伴急性肾损伤的独立危险因素（p <0.05）。单因素分析结果显示，死亡组与存活组高血压、糖尿病、机械通气、血管紧张素转化酶抑制剂（ACEI）药物、升压药≥2 种、白蛋白、血 pH 值、C 反应蛋白比较，差异有统计学意义（p <0.05）；多因素分析结果显示，机械通气[OR=3.224（95%CI：1.187，7.856）]、升压药≥2 种[OR=5.365（95%CI：1.535，16.758）]、白蛋白水平[OR=2.904（95%CI：1.102，6.869）]为影响感染性休克伴急性肾损伤预后的独立影响因素（p <0.05）。结论输血史、肾小球滤过率、APACHE Ⅱ评分为感染性休克伴急性肾损伤的独立危险因素，机械通气、ACEI 药物、升压药≥2 种、白蛋白水平为影响感染性休克伴急性肾损伤预后的独立影响因素。

Abstract:

To investigate the risk factors and the prognostic factors of septic shock with acute renal injury. Methods Sixty patients of septic shock with acute renal injury were selected as observation group, 60 cases of septic shock without acute renal injury were selected as control group in Taizhou Central Hospital from January 2012 to December 2015. The observation group was further divided into death group (14 cases) and survival group (46 cases). The clinical data were collected. Results Univariate analysis showed that the application of contrast agent, blood transfusion history, booster drugs≥2 types, glomerular filtration rate, central venous pressure, APACHE Ⅱscore, platelets, blood urea nitrogen, blood pH value and Creactive protein were significantly different between the observation group and the control group (p < 0.05).Multivariate analysis showed that the history of blood transfusion [OR = 5.431 (95% CI: 1.892, 13.265)],glomerular filtration rate [OR = 0.965 (95% CI: 0.784, 0.985)], APACHE Ⅱ score [OR = 3.896 (95% CI: 1.576,9.784)] were the independent risk factors for septic shock with acute renal injury (p < 0.05). Univariate analysis showed that there were significant differences in hypertension, diabetes mellitus, mechanical ventilation, ACEI drug, booster drugs ≥2 types, albumin, blood pH value and C-reactive protein between the death group and the survival group (p < 0.05). Multivariate analysis showed that mechanical ventilation [OR = 3.224 (95% CI:1.187, 7.856)], booster drugs ≥2 types [OR = 5.365 (95% CI: 1.535, 16.758)], albumin level [OR = 2.904(95% CI: 1.102, 6.869)] were the independent prognostic impact factors for the infectious shock with acute renal injury (p < 0.05). Conclusions The history of blood transfusion, glomerular filtration rate, APACHE Ⅱ score are the independent risk factors for septic shock with acute renal injury. Mechanical ventilation, ACEI drugs, booster drugs ≥2 types and albumin level are the independent prognostic impact factors for the infectious shock with acute renal injury.