摘要
目的探索脓毒症患者经生理盐水复苏72 h后血清氯离子水平与急性肾损伤(AKI)的关系。方法选取2015年1月-2019年5月山西医科大学第一医院重症监护室收治并用生理盐水早期复苏的200例脓毒症或脓毒症休克患者,按照72 h后的血清氯,分为高氯血症组(≥110 mmol/L)和非高氯血症组(<110 mmol/L),观察其初始血清氯离子浓度及肌酐、72 h后最高血清氯离子浓度及肌酐、基础肌酐清除率(Ccr)、初始急性生理功能和慢性健康状况评估Ⅱ(APACHEⅡ)评分、机械通气、肾替代治疗等指标,并计算72 h后血清氯离子变化值。结果两组患者年龄、性别、机械通气、肾替代治疗、Ccr、APACHEⅡ评分、72 h后最高血清氯离子浓度及72 h后血清氯离子浓度变化值比较,差异有统计学意义(P<0.05)。高氯血症组AKI发病率较非高氯血症组高(P<0.05)。单因素Logistic回归分析显示,72 h后最高血清氯离子浓度与AKI有关(P<0.05)。72 h后血清氯离子浓度变化值≥1.5 mmol/L和72 h后血清氯离子浓度变化值≥5.5 mmol/L与AKI也有关(P<0.05)。多因素Logistic回归分析显示,APACHEⅡ评分[OR=2.451(95%CI:1.961,2.880),P=0.000]、72 h后最高血清氯离子浓度[OR=2.023(95%CI:1.991,3.211),P=0.010]和72h后血清氯离子浓度变化值[OR=3.211(95%CI:2.347,3.630),P=0.006]是AKI发病的危险因素。结论脓毒症患者经生理盐水复苏72 h后血清高氯离子与AKI独立相关,且72 h后血清氯离子浓度变化值、APACHEⅡ评分也与AKI有关。
Objective To explore the relationship between serum chloride level and acute kidney injury(AKI)in patients with sepsis and sepsis shock after 72 h of normal saline resuscitation.Methods Using a retrospective cohort study,200 patients with sepsis,who were admitted to the intensive care unit of the First Hospital of Shanxi Medical University from January 2015 to May 2019,were resuscitated with normal saline at early stage and divided into high chloride group(≥110mmol/L)and non-high chloride group(<110mmol/L),according to serum chlorine after 72 h.The initial serum chloridion and creatinine,the highest serum chloridion and creatinine after 72 h,basal creatinine clearance rate(Ccr),initial acute physiology and chronic health evaluationⅡ score(APACHEⅡ),mechanical ventilation,renal replacement therapy and other indicators were observed and the changes of serum chloridion were calculated.Results After 72 h of resuscitation,the incidence of AKI in the high-chlorine group was 37.33%(28/75),which was higher than the non-high-chlorine group[16.00%(20/125)](P<0.05).There were significant differences in Age,sex,mechanical ventilation,renal replacement therapy,Ccr,APACHEⅡ score,the highest serum chloride concentration after 72 hours and the change of serum chloride concentration after 72 hours between two groups(P<0.05);univariate Logistic regression analysis found that the highest serum chloridion after 72 h was related to AKI(P<0.05).Serum chloridion change≥1.5 mmol/L and serum chloridion change≥5.5 mmol/L were related to AKI(P<0.05).After multivariate Logestic regression analysis,it was found that APACHEⅡ score[OR=2.451(95%CI:1.961,2.880),P=0.000],the highest serum chloridion after 72 h[OR=2.023(95%CI:1.991,3.211),P=0.010]and serum chloridion change[OR=3.211(95%CI:2.347,3.630),P=0.006]were risk factors for AKI.Conclusions Serum high chloride was independently associated with AKI after 72 h of resuscitation in patients with sepsis,and serum chloridion change and APACHEⅡ scores were also related to AKI.
作者
李娜
王美霞
韩继斌
李瑶
赵兰
姚哲放
Na Li;Mei-xia Wang;Ji-bin Han;Yao Li;Lan Zhao;Zhe-fang Yao(The First Medical College of Shanxi Medical University,Taiyuan,Shanxi 030001,China;Department of Critical Care Medicine,The First Hospital of Shanxi Medical University,Taiyuan,Shanxi 030001,China)
出处
《中国现代医学杂志》
CAS
2020年第14期30-35,共6页
China Journal of Modern Medicine
基金
山西省重点研发计划(指南)项目(No:201603D321066)。
