摘要
目的探讨液体正平衡与严重脓毒症性急性肾损伤（acute kidney injury，AKI）患者预后的相关性。方法回顾性分析中山市人民医院ICU的90例严重脓毒症AKI患者的临床资料，根据严重脓毒症性AKI患者28d预后情况分组为存活组（n=26）和死亡组（n=64），评价患者液体正平衡和预后的关系。结果（1）两组患者年龄及病情严重程度比较，差异无统计学意义，但死亡组容量负荷更高，与存活组相比较，其液体平衡的平均值更高[（1112．12±546．85）mL与（644．69±474．93）mL，P=0．00]、尿量更少[（1224．07±708．79）mL与（2032．36±723．53）mL，P=0．00）。（2）在ICU治疗期间，早、晚期持续性肾脏替代治疗（ continuous renalreplacement therapy, CRRT）组的患者病死率比较，差异无统计学意义；但晚期CRRT组患者平均每日容量负荷明显高于早期CRRT组患者[（1178．81±397．03）mL与（287．22±433．53）mL，P=0．00]，其氧合指数更差[（211．22±42．56）与（169．46±57．40），P=0．04]。（3）与严重脓毒症性AKI患者的28d病死率有关的变量分别为CRRT治疗、氧合指数和液体平衡〉500mL；其中液体平衡〉500mL是影响严重脓毒症AKI患者预后的独立危险因素；液体正平衡量越大，患者预后越差；CRRT治疗是影响严重脓毒症AKI患者预后的保护性因素。结论严重脓毒症性AKI患者有较高的病死率，持续的液体超负荷会导致严重脓毒症AKI患者病死率的增加，早期进行CRRT治疗能够减轻肾衰竭患者的液体潴留，改善组织氧合情况。
Objective To investigate the relation between positive fluid balance and the prognosis in severe sepsis patients with acute kidney injury （AKI）. Methods A retrospective analysis of clinical data of 90 patients in our department was carried out. According to the final outcome, patients were divided into survival group （n = 26） and non-survival group （ n = 64）, in which the relation between patients＇ positive fluid balance and the prognosis was evaluated. Results （1） There was no statistically significant difference in the age and severity between survival group and non-survival group of patients with severe sepsis and consequent AKI, but the patients in non-survival group had greater volume overload. Compared with the survival group, higher mean fluid balance [ （ 1 112. 12± 546. 85 ） mLvs. （644. 69±474. 93 ） mL, P = 0.001, and less urine output [ （1 224.07±708.79） mLvs. （2032.36±723.53） mL, P=0.00） in non-survival group. （2） There was no significant difference in mortality between early and late continuous renal replacement therapy （CRRT） during ICU care. However, the average daily fluid load in late CRRT patients was significantly greater than that in early CRRT patients [ （ 1178.81± 397.03） mLvs. （287.22±433.53） mL, P = 0.00 ] and the lung oxygenation index in late CRRT patients was significantly worse thanthat in early CRRT patients [ （211.22±42.56） vs. （169.46±57.40）, P=0.04] （3） The relevant variables to 28-day mortality in AKI patients with severe sepsis included CRRT treatment, oxygenation index and the average daily fluid balance 〉 500 mL. Among them, fluid balance 〉 500mL was an independent risk factor for AKI patients with severe sepsis. Their prognosis was worse if they had greater positive fluid balance. CRRT was the protective factor which could affect the prognosis of patients with severe sepsis complicated by AKI. Conclusions Patients with severe sepsis complicated by AKI has a high mortality. Persistent fluid overload can lead to increased mortality in patients with severe sepsis complicatedby AKI. Early CRRT can reduce fluid retention in patients with renal failure and improve oxygenation index .
出处
《中华急诊医学杂志》
CAS
CSCD
北大核心
2017年第2期172-175,共4页
Chinese Journal of Emergency Medicine
关键词
严重脓毒症
急性肾损伤
液体正平衡
Acute kidney injury
Severe sepsis
Positive fluid balance
