吴玉琴　刘凤琪　杨卿

[摘要] 目的 探討脓毒症急性肾损伤（AKIS）患者预后不良的相关危险因素。 方法 选取2018年1月至2020年10月在我院收治的148例AKIS患者进行随访调查，依据住院期间28 d内是否发生死亡将其分为死亡组（n=67）、存活组（n=81）;分析AKIS患者28 d内预后病死率，分别采用单因素比较法和多因素Logistic回归法，分别筛选如下因素：性别、年龄、BMI、心脑血管疾病、糖尿病、高血压、脓毒症严重程度、AKI分级、器官衰竭数量、机械通气、CRRT治疗、血管活性药物、低白蛋白血症、PCT、CRP、血乳酸、氧合指数、APACHEⅡ评分、SOFA评分等。 结果 148例AKIS患者28 d内病死率为45.27%（67/148）;影响AKIS患者预后死亡的危险因素包括高龄（OR=2.550）、脓毒症休克（OR=5.349）、AKI分级（OR=4.406）、器官衰竭数量（OR=3.347）、机械通气（OR=3.983）、低白蛋白血症（OR=3.022）、PCT（OR=6.013）、APACHEⅡ评分（OR=2.770）等。 结论 AKIS患者住院期间内具有很高的病死率，应根据筛选出的高危因素，进行早筛查、早预防、早治疗AKI，改善患者的预后，提高其生活质量。

[关键词] 脓毒症;急性肾损伤;预后;影响因素;危险因素

[中图分类号] R515.3          [文献标识码] B          [文章编号] 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.