本文選題：膿毒癥 + 急性腎損傷��； 參考：《首都醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的了解膿毒癥相關(guān)急性腎損傷患者腎臟功能轉(zhuǎn)歸及相關(guān)影響因素,為急性腎損傷臨床防治提供理論依據(jù)。方法前瞻性選取2016年1月至2016年12月進(jìn)入首都醫(yī)科大學(xué)附屬北京友誼醫(yī)院重癥醫(yī)學(xué)科的膿毒性急性腎損傷(acute kidney injury,AKI)患者,觀察其28天及90天腎功能及臨床轉(zhuǎn)歸,納入患者一般指標(biāo)、入組即刻生化、血常規(guī)、危重癥評(píng)分、血尿中性粒細(xì)胞明膠酶相關(guān)載脂蛋白(neutrophil gelatinase-associated lipocalin,NGAL)、金屬蛋白酶組織抑制因子-2(Tissue inhibitor of metalloproteinase-2,TIMP2)、胰島素樣生長(zhǎng)因子結(jié)合蛋白-7(Insulin-like growth factor binding protein-7,IGFBP-7)、肝型脂肪酸結(jié)合蛋白(liver fatty acid binding protein,LFABP)。根據(jù)90天腎功能轉(zhuǎn)歸將患者分為腎功能恢復(fù)組及腎功能未恢復(fù)組,通過(guò)兩組間對(duì)比,分析有統(tǒng)計(jì)學(xué)意義的早期預(yù)測(cè)因素,運(yùn)用受試者工作特征曲線(receiver operating characteristic curve,ROC)下面積及Logistic回歸分析評(píng)估這些因素對(duì)需行連續(xù)腎臟替代療法(continuous renal replacement therapy,CRRT)的AKI患者的預(yù)后價(jià)值。結(jié)果本課題共納入49名患者,其中男性29名,女性患者20名。整體膿毒癥相關(guān)AKI患者腎功能恢復(fù)率為49%,感染來(lái)源以肺部感染最常見�；�水平對(duì)比提示年齡、有心功能不全及高血壓疾病史、診斷膿毒癥AKI后24h APACHE-II評(píng)分、腎外器官SOFA評(píng)分、KDIGO分期、臟衰器官個(gè)數(shù)≥3個(gè)、血小板計(jì)數(shù)、乳酸水平、肺部感染、合并呼吸衰竭、少尿、機(jī)械通氣、應(yīng)用血管活性藥物、入組即刻尿TIMP-2、血NGAL、血LFABP濃度與腎功能恢復(fù)有關(guān)。logistic回歸模型分析顯示影響膿毒癥AKI患者腎功能恢復(fù)的因素有機(jī)械通氣、臟衰個(gè)數(shù)、急性生理和慢性健康狀況(acute physiology and chronic health evaluationⅡ,APACHE-II)評(píng)分、全球腎臟病預(yù)后組織(Kidney Disease:Improving Global Outcomes,KDIGO)分期、少尿、低蛋白血癥、血NGAL、尿TIMP-2。其中APACHE-II評(píng)分、腎外臟器SOFA評(píng)分、血NGAL、尿TIMP-2對(duì)腎功能恢復(fù)有較好的預(yù)測(cè)價(jià)值。結(jié)論1.患者年齡、有心功能不全及高血壓疾病史、診斷膿毒癥AKI后24h APACHE-II評(píng)分、腎外器官SOFA評(píng)分、KDIGO分期、臟衰器官個(gè)數(shù)≥3個(gè)、血小板計(jì)數(shù)、乳酸水平、肺部感染、合并呼吸衰竭、少尿、機(jī)械通氣、應(yīng)用血管活性藥物均與腎功能預(yù)后有關(guān),其中APACHE-II評(píng)分、SOFA評(píng)分可有效預(yù)測(cè)腎功能恢復(fù)。2.膿毒癥AKI診斷即刻血NGAL、尿TIMP-2水平對(duì)腎功能恢復(fù)有預(yù)測(cè)價(jià)值。
[Abstract]:Objective to investigate the outcome of renal function and its related factors in patients with acute renal injury associated with sepsis, and to provide theoretical basis for clinical prevention and treatment of acute renal injury.Methods from January 2016 to December 2016, patients with septic acute kidney injury were enrolled in the Department of intensive Medicine, Beijing Friendship Hospital affiliated to Capital Medical University, and their renal function and clinical outcome were observed 28 and 90 days later.Including general indexes of patients, immediate biochemistry, blood routine, critical illness score,According to the outcome of renal function in 90 days, the patients were divided into two groups: the recovery group and the unrecovered group. The early predictive factors were analyzed by comparing the two groups.The area under receiver operating characteristic (characteristic) and Logistic regression analysis were used to evaluate the prognostic value of these factors in AKI patients who needed continuous renal replacement therapy.Results A total of 49 patients were included in this study, including 29 males and 20 females.The recovery rate of renal function in patients with sepsis-related AKI was 49. Pulmonary infection was the most common source of infection.Baseline level contrast indicated that age, history of cardiac insufficiency and hypertension, 24 h APACHE-II score after diagnosis of sepsis, SOFA score of extrarenal organ and KDIGO stage, number of organ of visceral failure 鈮，

本文編號(hào)：1744772