摘要
目的探讨脓毒性休克患者内皮功能损伤对急性肾损伤(AKI)发生及预后的影响。方法选取2022年6月至2024年12月南京市江宁医院156例脓毒性休克患者为研究对象,根据是否发生AKI将其分为对照组(未发生AKI,78例)和观察组(发生AKI,78例)。比较两组患者的氧合指数、平均动脉压(MAP)、动脉血乳酸、血清肌酐(SCr)、血尿素氮(BUN)、可溶性血栓调节蛋白(sTM)和24 h液体净入量等临床资料,并比较两组的血小板、白蛋白、血钠、血钾、C反应蛋白(CRP)等实验室指标。此外,采用多因素logistic回归法分析脓毒性休克合并AKI的相关影响因素。结果观察组的氧合指数低于对照组,观察组的MAP、SCr、sTM、乳酸、24 h液体净入量和BUN水平高于对照组,差异有统计学意义(P<0.05)。观察组的血钠和血小板水平低于对照组,差异有统计学意义(P<0.05)。两组患者的白蛋白、血钾以及CRP等比较,差异无统计学意义(P>0.05)。多因素logistic回归分析结果显示,sTM、SCr、24 h液体净入量、MAP、动脉血乳酸是脓毒性休克患者合并AKI的独立危险因素(P<0.05)。结论脓毒性休克患者合并AKI的相关影响因素主要有MAP、SCr、sTM、24 h液体净入量、动脉血乳酸等,以上因素对患者的预后有直接影响;内皮细胞损伤会导致或加重肾功能损伤。
Objective To investigate the Effect of endothelial dysfunction on the occurrence and prognosis of acute kidney injury(AKI)in patients with septic shock.Methods A total of 156 patients with septic shock in Nanjing Jiangning Hospital from June 2022 to December 2024 were selected as the research objects.According to whether AKI occurred,they were divided into control group(without AKI,78 cases)and observation group(with AKI,78 cases).The oxygenation index,mean arterial pressure(MAP),arterial blood lactic acid,serum creatinine(SCr),blood urea nitrogen(BUN),soluble thrommomodulin(sTM)and 24 h net fluid intake were compared between the two groups,and the laboratory indicators such as platelet,albumin,serum sodium,serum potassium and C-reactive protein(CRP)were compared between the two groups.In addition,multivariate logistic regression was used to analyze the related factors of septic shock complicated with AKI.Results The oxygenation index of the observation group was lower than that of the control group,and the MAP,SCr,sTM,lactic acid,24 h net fluid intake and BUN levels of the observation group were higher than those of the control group,and the differences were statistically significant(P<0.05).The levels of serum sodium and platelet in the observation group were lower than those in the control group,and the differences were statistically significant(P<0.05).There were no statistically significant differences in albumin,serum potassium and CRP between the two groups(P>0.05).The results of multivariate logistic regression analysis showed that sTM,SCr,24 h net fluid intake,MAP,arterial blood lactate were independent risk factors for septic shock patients with AKI(P<0.05).Conclusion The related factors of septic shock patients with AKI mainly include MAP,SCr,sTM,24 h net fluid intake,arterial blood lactic acid,etc.The above factors have a direct impact on the prognosis of patients.Endothelial cell injury can cause or aggravate renal function damage.
作者
王倩
毛东旭
WANG Qian;MAO Dongxu(Department of Intensive Care Medicine,Nanjing Jiangning Hospital,Jiangsu Province,Nanjing 211000,China)
出处
《中国当代医药》
2025年第31期43-46,共4页
China Modern Medicine
关键词
脓毒性休克
内皮功能损伤
急性肾损伤
影响因素
Septic shock
Endothelial dysfunction
Acute kidney injury
Influencing factor
