摘要
目的:分析动脉血气指标监测在连续性肾脏替代治疗(CRRT)的脓毒症伴急性肾损伤(AKI)患者预后中的预测价值。方法:选择行CRRT治疗的185例脓毒症合并AKI患者为研究对象,根据30 d预后情况将其分为预后不良组(62例)和预后良好组(123例),通过单因素和多因素Cox回归分析患者预后不良的独立影响因素。通过拟合曲线和Pearson分析探讨动脉血气指标与预后的关系。依据独立因素构建列线图预测模型,并对模型进行验证。结果:单因素和多因素Cox回归分析显示,急性生理与慢性健康状况评估Ⅱ(APACHEⅡ)评分、合并器官衰竭数量、乳酸(Lac)、肌酐(Scr)、动脉血二氧化碳分压(PaCO_(2))是患者预后不良的独立危险因素(P均<0.05);动脉血氧分压(PaO_(2))是其保护因素(P<0.05)。Lac、PaCO_(2)升高,患者预后不良的概率呈上升趋势,而PaO_(2)升高,患者预后不良的概率呈下降趋势。PaCO_(2)、Lac、APACHEⅡ评分、合并器官衰竭数量、Scr之间呈正相关(P均<0.05),PaO_(2)与APACHEⅡ评分、合并器官衰竭数量、Scr、PaCO_(2)、Lac呈负相关(P均<0.05)。构建的列线图预测模型性能良好。结论:动脉血气分析指标监测对行CRRT治疗的脓毒症伴AKI患者的预后有预测价值。
Objective:To analyze the predictive value of arterial blood gas monitoring in the prognosis of sepsis patients with acute renal injury(AKI)undergoing continuous replacement therapy(CRRT).Methods:Totally,185 sepsis patients with AKI who underwent CRRT treatment were selected as the research subjects.According to the 30-day prognosis,they were divided into a poor prognosis group(62 cases)and a good prognosis group(123 cases).Univariate and multivariate COX regression analyses were used to identify independent influencing factors of poor prognosis in patients.The relationship between arterial blood gas indicators and prognosis was explored through curve fitting and Pearson analysis.A column chart prediction model was constructed based on independent factors and validated.Results:Univariate and multivariate Cox regression analyses showed that acute physiology and chronic health assessmentⅡ(APACHEⅡ)score,number of concurrent organ failures,lactate(Lac),creatinine(Scr)and arterial partial pressure of carbon dioxide(PaCO_(2))were independent risk factors for poor prognosis in patients(all P<0.05).Arterial partial pressure of oxygen(PaO_(2))was a protective factor(P<0.05).The increase of Lac and PaCO_(2)increased the probability of poor prognosis in patients,while the increase of PaO_(2)decreased the probability of poor prognosis in patients.There was a positive correlation between PaCO_(2),Lac,APACHE II score,number of concurrent organ failures(P<0.05)and Scr,while PaO_(2)was negatively correlated with APACHE II score,number of concurrent organ failures,Scr,PaCO_(2)and Lac(P<0.05).The constructed column chart prediction model had good performance.Conclusion:Monitoring arterial blood gas analysis indicators has predictive value for the prognosis of sepsis patients with AKI undergoing CRRT treatment.
作者
庞秋菊
白燕
陈灿
伍永升
PANG Qiu-ju;BAI Yan;CHEN Can;WU Yong-sheng(Department of Respiratory and Critical Care Medicine,3201st Hospital,Shaanxi Hanzhong 723000,China)
出处
《内科急危重症杂志》
2025年第3期255-259,共5页
Journal of Critical Care In Internal Medicine
关键词
动脉血气指标
连续性肾脏替代治疗
急性肾损伤
预后
列线图模型
Arterial blood gas index
Continuous renal replacement therapy
Acute kidney injury
Prognosis
Nomograph model
