毒血症

危重患者脓毒血症性急性肾损伤的临床特征和转归

更新时间:2011-11-11 13:07:21 | fx_2b0b9e35

  脓毒血症是危重患者急性肾损伤最为常见的病因,但有关脓毒血症性急性肾损伤的资料非常有限。为此,澳大利亚墨尔本austin & repatriation医学中心内科和重症医学系sean m. bagshaw等人从2000年9月到2001年12月在23个国家54家医院针对脓毒血症性和非脓毒血症性急性肾损伤的危重患者进行了一项前瞻性观察。

  共1753例患者入选。以脓毒血症为病因者833例(占总例数的47.5%),主要感染源是胸部和腹部(占总感染源的54.3%)。 脓毒血症性急性肾损伤者血流动力学和实验室指标异常以及疾病的严重程度都较非脓毒血症性急性肾损伤者高,对机械通气和血管活性治疗的需求也更大。入选时两组间患者肾功能和接受肾脏替代治疗者比例没有差异(接受肾脏替代治疗比例分别为72%和71%,p = 0.83)脓毒血症性急性肾损伤患者中少尿更为常见(两组分别为67 %和 57%, p < 0.001)。 住院死亡率也更高 (两组分别为70.2% 和 51.8%, p < 0.001)。经协同变量校正后,其死亡风险仍高于非脓毒血症性急性肾损伤组(风险比1.48,95%可信区间1.17 ~1.89,p = 0.001)存活者住院时间中位数(四分位距)也较长[(两组分别为37天(19~59)和21天(12~42)]。

  但脓毒血症性急性肾损伤患者出院时血清肌酐水平[(分别为106?mol/l (73~158)和121?mol/l (88 ~184), p = 0.01]和对肾脏替代治疗的依赖性(分别为9%和14%,p = 0.052)与对照组相比却呈现出降低的趋势。

  该研究结论认为:脓毒血症性急性肾损伤患者病情危笃、疾病负荷重、急性生理学异常程度高、死亡风险增加、住院时间也较长,但却表现出更容易达到肾功能恢复和脱离肾脏替代治疗的趋势。

  笔者(湖北协和医院肾病科专家杨晓)翻译自

  septic acute kidney injury in critically ill patients: clinical characteristics and outcomes

  clin j am soc nephrol 2: 431-439, 2007

  doi: 10.2215/cjn.03681106

  sepsis is the most common cause of acute kidney injury (aki) in critical illness, but there is limited ***rmation on septic aki. a prospective, observational study of critically ill patients with septic and nonseptic aki was performed from september 2000 to december 2001 at 54 hospitals in 23 countries. a total of 1753 patients were enrolled. sepsis was considered the cause in 833 (47.5%); the predominant sources of sepsis were chest and abdominal (54.3%)。 septic aki was associated with greater aberrations in hemodynamics and laboratory parameters, greater severity of illness, and higher need for mechanical ventilation and vasoactive therapy. there was no difference in enrollment kidney function or in the proportion who received renal replacement therapy (rrt; 72 versus 71%; p = 0.83)。 oliguria was more common in septic aki (67 versus 57%; p < 0.001)。 septic aki had a higher in-hospital case-fatality rate compared with nonseptic aki (70.2 versus 51.8%; p < 0.001)。 after adjustment for covariates, septic aki remained associated with higher odds for death (1.48; 95% confidence interval 1.17 to 1.89; p = 0.001)。 median (iqr) duration of hospital stay for survivors (37 [19 to 59] versus 21 [12 to 42] d; p < 0.0001) was longer for septic aki. there was a trend to lower serum creatinine (106 [73 to 158] versus 121 [88 to 184] ?mol/l; p = 0.01) and rrt dependence (9 versus 14%; p = 0.052) at hospital discharge for septic aki. patients with septic aki were sicker and had a higher burden of illness and greater abnormalities in acute physiology. patients with septic aki had an increased risk for death and longer duration of hospitalization yet showed trends toward greater renal recovery and independence from rrt.

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