中华老年医学杂志
中華老年醫學雜誌
중화노년의학잡지
Chinese Journal of Geriatrics
2015年
6期
641-644
,共4页
丁毅%方强%吴晓梁%裘晓蕙
丁毅%方彊%吳曉樑%裘曉蕙
정의%방강%오효량%구효혜
脓毒症%急性肾损伤%危险因素%预后
膿毒癥%急性腎損傷%危險因素%預後
농독증%급성신손상%위험인소%예후
Sepsis%Acute kidney injury%Risk factors%Prognosis
目的 探讨在ICU老年脓毒症患者并发急性肾损伤(AKI)的危险因素和老年脓毒症患者的预后. 方法 回顾性分析2010年5月至2014年5月浙江大学医学院附属第一医院ICU病房老年脓毒症患者共108例.根据是否发展为急性肾损伤把患者分为AKI组和非AKI组,比较两组的临床特征,实验室和生理学数据,并以多因素Logistic回归方程分析脓毒症并发AKI相关的独立危险因素.并对临床转归进行分析总结. 结果 108例ICU老年脓毒症患者,60例发生AKI,发生率为55.6％.脓毒症AKI组与脓毒症非AKI组比较基础肾小球滤过率、平均动脉压均较低(t=4.536、3.28),凝血酶原时间值(t=3.053)、多器官功能衰竭(MODS)评分(t=2.201)、急性生理学与慢性健康状况评分系统评分(t=3.423),合并休克(x2=5.400)、2周内外科手术史较脓毒症非AKI组高(x2=5.625)(均P＜0.05).多因素Logistic回归分析提示,平均动脉压(OR=0.833)、基础肾小球滤过率(OR=0.776)、MODS评分(OR=2.039)是老年脓毒症患者发生AKI的独立危险因素.AKI组住院死亡率(P=0.001),住ICU时间(P=0.026)和总住院时间(P=0.042)均高于非AKI组. 结论 ICU老年脓毒症患者并发AKI的独立危险因素为平均动脉压、基础肾小球滤过率、MODS评分,脓毒症AKI患者住院病死率高,住ICU时间及总住院时间延长.
目的 探討在ICU老年膿毒癥患者併髮急性腎損傷(AKI)的危險因素和老年膿毒癥患者的預後. 方法 迴顧性分析2010年5月至2014年5月浙江大學醫學院附屬第一醫院ICU病房老年膿毒癥患者共108例.根據是否髮展為急性腎損傷把患者分為AKI組和非AKI組,比較兩組的臨床特徵,實驗室和生理學數據,併以多因素Logistic迴歸方程分析膿毒癥併髮AKI相關的獨立危險因素.併對臨床轉歸進行分析總結. 結果 108例ICU老年膿毒癥患者,60例髮生AKI,髮生率為55.6％.膿毒癥AKI組與膿毒癥非AKI組比較基礎腎小毬濾過率、平均動脈壓均較低(t=4.536、3.28),凝血酶原時間值(t=3.053)、多器官功能衰竭(MODS)評分(t=2.201)、急性生理學與慢性健康狀況評分繫統評分(t=3.423),閤併休剋(x2=5.400)、2週內外科手術史較膿毒癥非AKI組高(x2=5.625)(均P＜0.05).多因素Logistic迴歸分析提示,平均動脈壓(OR=0.833)、基礎腎小毬濾過率(OR=0.776)、MODS評分(OR=2.039)是老年膿毒癥患者髮生AKI的獨立危險因素.AKI組住院死亡率(P=0.001),住ICU時間(P=0.026)和總住院時間(P=0.042)均高于非AKI組. 結論 ICU老年膿毒癥患者併髮AKI的獨立危險因素為平均動脈壓、基礎腎小毬濾過率、MODS評分,膿毒癥AKI患者住院病死率高,住ICU時間及總住院時間延長.
목적 탐토재ICU노년농독증환자병발급성신손상(AKI)적위험인소화노년농독증환자적예후. 방법 회고성분석2010년5월지2014년5월절강대학의학원부속제일의원ICU병방노년농독증환자공108례.근거시부발전위급성신손상파환자분위AKI조화비AKI조,비교량조적림상특정,실험실화생이학수거,병이다인소Logistic회귀방정분석농독증병발AKI상관적독립위험인소.병대림상전귀진행분석총결. 결과 108례ICU노년농독증환자,60례발생AKI,발생솔위55.6％.농독증AKI조여농독증비AKI조비교기출신소구려과솔、평균동맥압균교저(t=4.536、3.28),응혈매원시간치(t=3.053)、다기관공능쇠갈(MODS)평분(t=2.201)、급성생이학여만성건강상황평분계통평분(t=3.423),합병휴극(x2=5.400)、2주내외과수술사교농독증비AKI조고(x2=5.625)(균P＜0.05).다인소Logistic회귀분석제시,평균동맥압(OR=0.833)、기출신소구려과솔(OR=0.776)、MODS평분(OR=2.039)시노년농독증환자발생AKI적독립위험인소.AKI조주원사망솔(P=0.001),주ICU시간(P=0.026)화총주원시간(P=0.042)균고우비AKI조. 결론 ICU노년농독증환자병발AKI적독립위험인소위평균동맥압、기출신소구려과솔、MODS평분,농독증AKI환자주원병사솔고,주ICU시간급총주원시간연장.
Objective To investigate the risk factors and prognosis of acute kidney injury (AKI) in elderly patients with sepsis in intensive care unit (ICU).Methods Clinical data of 108 elderly patients diagnosed as sepsis admitted in ICU in our hospital,from May 2010 to May 2014 were analyzed retrospectively.Patients were divided into two groups:the AKI group and the non-AKI group.Clinical characteristics,laboratory and physiologic data were compared between groups.Multivariate Logistic regression analysis was used to analyze the independent risk factors for AKI in these patients,and clinical outcome was retrospectively analyzed.Results Among the 108 elderly patients,60 patients developed AKI and the incidence was 55.6％.Baseline glomerular filtration rate (GFR) and mean arterial pressure (MAP) were lower in the AKI group than in non-AKI group (t=4.536 and 3.28).Prothrombin time (PT) (t=3.053),multiple organ dysfunction score (MODS) (t =2.201),acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score (t=3.423),the incidence of septic shock (x2 =5.400) and patients undergoing surgical operation within two weeks (x2 =5.625) were higher or longer in AKI group than in non-AKI group (all P＜0.05).Multivariate Logistic regression analysis showed that MAP (OR =0.833),baseline GFR (OR=0.776),MODS (OR=2.039) were independent risk factors for AKI occurrence.Hospital mortality,length of stay in ICU and hospitalization time were higher or longer in AKI group than in non-AKI group (P=0.001,0.026 and 0.042).Conclusions MAP,baseline GFR and MODS are the independent risk factors for AKI occurrence in elderly adults with sepsis in ICU.Hospital mortality,length of stay in ICU and hospitalization time are increased in sepsis patients combined with AKI.
