吳玉琴　劉鳳琪　楊卿

[摘要] 目的 探討膿毒癥急性腎損傷（AKIS）患者預(yù)后不良的相關(guān)危險因素。 方法 選取2018年1月至2020年10月在我院收治的148例AKIS患者進(jìn)行隨訪調(diào)查，依據(jù)住院期間28 d內(nèi)是否發(fā)生死亡將其分為死亡組（n=67）、存活組（n=81）;分析AKIS患者28 d內(nèi)預(yù)后病死率，分別采用單因素比較法和多因素Logistic回歸法，分別篩選如下因素：性別、年齡、BMI、心腦血管疾病、糖尿病、高血壓、膿毒癥嚴(yán)重程度、AKI分級、器官衰竭數(shù)量、機(jī)械通氣、CRRT治療、血管活性藥物、低白蛋白血癥、PCT、CRP、血乳酸、氧合指數(shù)、APACHEⅡ評分、SOFA評分等。 結(jié)果 148例AKIS患者28 d內(nèi)病死率為45.27%（67/148）;影響AKIS患者預(yù)后死亡的危險因素包括高齡（OR=2.550）、膿毒癥休克（OR=5.349）、AKI分級（OR=4.406）、器官衰竭數(shù)量（OR=3.347）、機(jī)械通氣（OR=3.983）、低白蛋白血癥（OR=3.022）、PCT（OR=6.013）、APACHEⅡ評分（OR=2.770）等。 結(jié)論 AKIS患者住院期間內(nèi)具有很高的病死率，應(yīng)根據(jù)篩選出的高危因素，進(jìn)行早篩查、早預(yù)防、早治療AKI，改善患者的預(yù)后，提高其生活質(zhì)量。

[關(guān)鍵詞] 膿毒癥;急性腎損傷;預(yù)后;影響因素;危險因素

[中圖分類號] R515.3? ? ? ? ? [文獻(xiàn)標(biāo)識碼] B? ? ? ? ? [文章編號] 1673-9701（2021）22-0094-04

Impacting factors of poor prognosis in septic patients with acute kidney injury

WU Yuqin? ?LIU Fengqi? ?YANG Qing

Intensive Care Unit， The First People′s Hospital of Huzhou， Huzhou? ?313000， China

[Abstract] Objective To investigate the related risk factors of poor prognosis in septic patients with acute kidney injury （AKIS）. Methods A total of 148 patients with AKIS admitted to and treated in our hospital from January 2018 to October 2020 were selected for follow-up investigation. And they were divided into the death group （n=67） and the survival group （n=81） according to whether death occurred within 28 days during hospitalization time. The 28-day mortality of patients with AKIS was analyzed. Univariate comparison and multivariate logistic regression were used. The following factors were screened， including gender， age， BMI， cardio cerebrovascular disease， diabetes， hypertension， sepsis severity， AKI level， number of organ failure， mechanical ventilation， CRRT treatment， vasoactive drugs， hypoalbuminemia， PCT， CRP， blood lactic acid， oxygenation index， Apache II score， SOFA score， etc. Results The mortality of 148 patients within 28 days with AKIS was 45.27% （67/148）. The risk factors impacting the prognosis and death of patients with AKIS included the elderly （OR=2.550）， septic shock （OR=5.349）， AKI level （OR=4.406）， number of organ failure （OR=3.347）， mechanical ventilation （OR=3.983）， hypoalbuminemia （OR=3.022）， PCT （OR=6.013）， APACHE II score （OR=2.770）， etc. Conclusion Patients with AKIS have a high mortality rate during hospitalization. Early screening， early prevention and early treatment of AKI should be carried out according to the screened high-risk factors， so as to improve the prognosis of patients and increase their quality of life.