MODS并发急性肾损伤相关临床因素探讨

目的:观察ICU病房多器官功能障碍综合征(MODS)并发急性肾损伤(AKI)的患者,探讨AKI与各脏器功能障碍之间的关系及相关危险因素。方法:ICU病房收治的84例MODS的患者,分为非急性肾损伤组(NO-AKI组,56例)和急性肾损伤组(AKI组,28例),观察不同分组患者的预后,AKI与各脏器功能的关系,以及机械通气、完成早期目标性液体复苏、院内感染、消化道出血并发症对AKI的影响。结果:AKI组入院APACHEⅡ评分明显高于NO-AKI组:AKI组住院期间各脏器功能最差指标与NO-AKI组比较:谷丙转氨酶、白细胞、血糖明显升高,格拉斯哥昏迷评分偏低,氧合指数(PaO2/FiO2)、白蛋白、血小板水平低于NO-AKI组,有统计学差异;休克指数(脉搏/收缩压)、总胆红素较NO-AKI组升高,但未见统计学差异;AKI组机械通气、院内感染、消化道出血的发生率明显高于NO-AKI组;Kendall's相关分析显示院内感染的发生与RIFLE分级具有明显的正相关关系,发生迟发性肾损伤与机械通气、院内感染、消化道出血有正相关关系,而与是否完成早期目标性液体复苏、胰岛素强化治疗有负相关关系,但未见统计学意义。结论:合并AKI的MODS患者死亡率增加,防治呼吸衰竭、消化道出血、院内感染可能有利于降低肾损伤的程度,改善其它脏器的功能对急性肾损伤的治疗有重要意义。

Related clinical factors of acute renal injury in MODS patients

Objective：To investigate the risk factors of acute kidney injury （AKI）in patients with multiple organ dysfunction syndrome （MODS）. Method：Eighty four patients with MODS were divided into non--acute renal injury group （NO-AKI group,56 eases） and acute renal injury group （AKI group,28 cases）. The prognosis , and- relationship with the other organs were observed. Further,and the impact of mechanical ventilation fluid resuseita- tion,nosocomial infections,gastrointestinal bleeding on the AKI was also evaluated. Result： APACHE Ⅱ score of AKI group was significantly higher than that of NO-AKI group. The ratio of mechanical ventilation,nosoeomial infections,gastrointestinal bleeding in AKI group were significantly higher than that in NO-AKI group,and the incidence of completion target of early fluid resuscitation, intensive insulin therapy was decreased, with no statistically significant difference. Alanine aminotransferase,white blood cells,blood glucose increased,Glasgow coma score ox- ygenation index （PaO2/FiO2）, serum albumin, platelet were significantly lower than that of NO-AKI group. Though shock index and total bilirubin were higher than that of NO-AKI group, no statistical difference was shown. Kendall＇s correlation analysis showed that the incidence of nosocomial infection with RIFLE classification has a significant positive correlation （P〈0.05）. Delayed occurrence of renal injury and mechanical ventilation, nos- ocomial infections,gastrointestinal bleeding have a positive correlation relationship. While the completion of early goal and liquid recovery, intensive insulin therapy had no significant negative correlations AKI. Conclusion： The AKI may increase the mortality of patients with MODS. The treatments for respiratory failure, gastrointestinal bleeding and nosoeomial infection may reduce the degree of renal injury.