| 摘要: |
| 目的：探讨儿科重症监护病房（PICU）脓毒症患儿并发急性肾损伤其预后的危险因素。方法：回顾性分析2014年12月至2020年1月我院PICU收治的80例脓毒症患儿的临床资料，采用Logistic多因素分析找出脓毒症并发急性肾损伤的危险因素。结果：所有患儿进入PICU后进行24 h监测，发现有23例并发了急性肾损伤，发生率为28.75%（23/80），其中死亡10例（43.48%）。单因素分析显示，两组患儿脓毒症分期、降钙素原、动脉血二氧化碳分压、碱剩余、入院48 h及96 h肌酐水平、白蛋白、胱抑素C、尿量、机械通气、使用血管活性药物、死亡发生率比较差异有统计学意义（P<0.05）；多因素Logistic回归分析显示，脓毒性休克、低水平白蛋白、高水平胱抑素是PICU脓毒症患儿发生急性肾损伤的危险因素（OR分别为3.50、2.78、3.51，P<0.05）。单因素分析发现，机械通气、使用血管活性药物、脓毒症分期、72 h液体正平衡、6 h乳酸清除率<10%均与PICU脓毒症并发急性肾损伤患儿死亡具有相关性（P<0.05）；多因素Logistic回归分析显示，液体正平衡及乳酸清除率低均为PICU脓毒症并急性肾损伤患儿预后的危险因素（OR分别为3.82、3.90，P<0.05）。结论：PICU脓毒症患儿并发肾损伤受多种因素共同影响，临床应密切监测脓毒症发展情况、血清白蛋白及胱抑素C水平变化，对患儿及时进行干预治疗，降低脓毒症患儿并发急性肾损伤的发生率及病死率。 |
| 关键词: 儿科重症监护病房 脓毒症 急性肾损伤 危险因素 预后 |
| DOI：doi:10.13407/j.cnki.jpp.1672-108X.2020.10.003 |
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| 基金项目:江苏省自然科学基金,编号BK20171217。 |
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| Risk Factors for Prognosis of Sepsis Complicated with Acute Kidney Injury in Children |
| Wang Lili, Zhao Zhongxiu, Zhang Xinqing |
| (Xuzhou Children’s Hospital, Jiangsu Xuzhou 221002, China) |
| Abstract: |
| Objective: To probe into the risk factors for prognosis of sepsis complicated with acute kidney injury in children from pediatric intensive care unit (PICU). Methods: Retrospective analysis was performed on clinical data of 80 children with sepsis admitted into PICU of our hospital from Dec. 2014 to Jan. 2020. Logistic multivariate analysis was used to analyze the risk factors for prognosis of sepsis complicated with acute kidney injury in children. Results: All children were monitored for 24 h in PICU. There were 23 cases complicated with acute kidney injury, with the incidence of 28.75% (23/80), of which 10 cases (43.48%) died. Univariate analysis showed that there were statistically significant differences between two groups in sepsis stage, procalcitonin, arterial partial pressure of carbon dioxide, alkali residual, creatinine levels at 48 and 96 h after admission, albumin, cystatin C, urine volume, mechanical ventilation, application of vasoactive drugs and mortality (P<0.05). Multivariate Logistic regression analysis showed that septic shock, low albumin levels and high creatinine levels were risk factors for acute kidney injury in children with sepsis from PICU (OR was 3.50, 2.78 and 3.51, respectively, P<0.05). Unifactorial analysis showed that mechanical ventilation, application of vasoactive drugs, sepsis stage, positive fluid balance at 72 h and lactic acid clearance rate at 6 h <10% were all correlated with death of children with sepsis complicated with acute kidney injury from PICU (P<0.05). Multivariate Logistic regression analysis showed that positive fluid balance and low lactate clearance rate were risk factors for prognosis in children with sepsis complicated with acute kidney injury from PICU (OR was 3.82 and 3.90, respectively, P<0.05). Conclusion: Children with sepsis complicated with acute kidney injury from PICU is affected by multiple factors. The development of sepsis, changes in serum albumin and cystatin C levels should be closely monitored in clinic, and timely intervention and treatment of children should be carried out to reduce the incidence and mortality of children with sepsis complicated with acute kidney injury. |
| Key words: pediatric intensive care unit sepsis acute kidney injury risk factors prognosis |
