摘要
目的 探讨脓毒症合并急性肾损伤患者采用连续性血液净化治疗的效果及预后影响因素。方法 本研究中共纳入250例脓毒症合并急性肾损伤患者,选取时间为2019年5月至2022年5月,所有患者均来源于驻马店市中心医院,进行回顾性分析。所有患者均接受连续性血液净化治疗,对患者28 d转归情况进行记录,分为死亡组(133例)和存活组(117例)。统计死亡组和存活组患者各项基线资料并进行对比,然后进行多因素回归分析模型,筛选患者预后不良的高危因素。结果 死亡组患者APACHEⅡ、SOFA评分及有创机械通气占比均相较于存活组升高(t=5.824、5.311,χ~2=49.209,均P<0.05);死亡组患者糖尿病、冠心病、AKI分期Ⅲ期、感染性休克、心功能Ⅳ级、高钾血脂症、严重代谢性酸中毒占比及CRP指标水平均相较于存活组升高,且死亡组患者ICU住院时间相较于存活组延长(χ~2=49.079、30.401、42.549、26.737、35.800、29.709、30.682、22.654、62.850;t=7.412、9.605,均P<0.05),而两组患者性别、BMI、高血压占比、血红蛋白指标等进行对比,未见明显差异(均P>0.05);脓毒症合并急性肾损伤患者采用连续性血液净化治疗预后不良的高危因素有年龄、冠心病、AKI分期Ⅲ期、感染性休克、心功能Ⅳ级、高钾血脂症、APACHEⅡ评分、SOFA评分(OR=1.391、7.838、7.360、8.306、8.793、3.473、2.832、3.543,均P<0.05)。结论 脓毒症合并急性肾损伤患者采用连续性血液净化治疗预后不良的高危因素有年龄、冠心病、AKI分期Ⅲ期、感染性休克、心功能Ⅳ级、高钾血脂症等,临床应据此采取相关措施,以改善患者预后。
Objective To investigate the effect and prognostic factors of continuous blood purification in patients with sepsis complicated with acute kidney injury.Methods A total of 250 patients with sepsis complicated with acute kidney injury were included in this study from May 2019 to May 2022.All patients were from Zhumadian Downtown Hospital for retrospective analysis.All patients received continuous blood purification treatment,and the outcomes of patients at 28 days were recorded,and they were divided into death group(133 cases)and survival group(117 cases).The baseline data of patients in the death group and the survival group were counted and compared,and then a multivariate regression analysis model was carried out to screen the high-risk factors for poor prognosis.Results The scores of APACHEⅡ,SOFA and invasive mechanical ventilation in the death group were higher than those in the survival group(t=5.824,5.311,χ2=49.209,all P<0.05).Compared with the survival group,the levels of diabetes,coronary heart disease,AKI stage III,septic shock,cardiac function grade IV,hyperkalemia,severe metabolic acidosis and CRP indexes in the death group were all higher.The length of ICU stay in the death group was longer than that in the survival group(χ2=49.079,30.401,42.549,26.737,35.800,29.709,30.682,22.654,62.850).t=7.412,9.605,bothP<0.05),but there were no significant differences in gender,BMI,proportion of hypertension and hemoglobin index between the two groups(all P>0.05).The risk factors for poor prognosis of patients with sepsis complicated with acute kidney injury by continuous blood purification were age,coronary heart disease,AKI stage III,septic shock,cardiac function grade IV,hyperkalemia,APACHE II score,SOFA score(OR=1.391,7.838,7.360,8.306,8.793,3.473,2.832,3.543,all P<0.05).Conclusion The high risk factors for poor prognosis of patients with sepsis complicated with acute kidney injury by continuous blood purification include age,coronary heart disease,AKI stage III,septic shock,cardiac function grade IV,hyperkalemia,etc.Relevant clinical measures should be taken to improve the prognosis of patients.
作者
孟贺玲
王亚男
MENG He-ling;WANG Ya-nan(Blood Purification Room,Zhumadian Central Hospital,Zhumadian 463000,Henan Province,China)
出处
《罕少疾病杂志》
2025年第1期99-101,共3页
Journal of Rare and Uncommon Diseases
关键词
脓毒症
急性肾损伤
连续性血液净化
治疗效果
预后
影响因素
Sepsis
AcuteKidneyInjury
ContinuousBloodPurification
TherapeuticEffect
Prognosis
InfluencingFactor
