Clinical Study Of Acute Kidney Injury In Patients With Septic Shock

【Objective】: To describe the clinical characteristics and risk factors associated with early acute kidney injury(AKI) in septic shock, investigate the causes of AKI in patients with septic shock and its relationship with prognosis. 【Method】: In the retrospective analysis way, we collect a total of 112 patients in the ICU from January 2010 to December 2013 in the diagnosis of septic shock,then divided into the four groups for NAKI, AKI stage 1, 2, 3 in based on AKIN staging, to mutually compare the clinical features, laboratory data and the way to the use of antibiotics and liquid recovery,and to analyze the related factors of AKI and its relationship with prognosis. 【Results】: The APACHE Ⅱscore of AKI group is obviously higher than that of NAKI group(P < 0.05),the blood PH and HCO3-of the AKI stage 2 and 3 groups are lower than those of NAKI and AKI stage 1 group(P < 0.05), the CRP of the AKI stage 2 and 3 groups is higher than NAKI and AKI stage 1 group(P < 0.05); the cases of two or more kinds of vasopressors in AKI group are more than NAKI group(P < 0.05). The amount of preliminary rehydration(shock early 6 hours) of AKI group is obviously more than NAKI group(P < 0.05); Along with the aggravation of AKI,the need of mechanical ventilation significantly increase(P < 0.05).And, with the aggravation of AKI, the number of organ damage increase gradually(P < 0.05). With the increase of AKI staging, the mortality of patients is rising. The longer patients with shock delayed to use antibiotic, the greater the chance of AKI occurred, a poor prognosis would come. Multiple factors regression analysis shows that APATHE II grade(OR 1.065, 95% CI 1.065 to 1.062;P = 0.001) and the number of organ damage(OR 1.378, 95% CI 1.378 to 1.133; P = 0.001) are the independent risk factors of AKI. 【Conclusions】: The occurrence rate of acute kidney injury in septic shock is high, with poor outcome. The occurrence of AKI is closely associated with the severity of the shock, the extent of systemic inflammatory response, inappropriate fluid overload and the delayed use of antibiotics. In the process of treatment of septic shock, closely monitoring the hemodynamic status, avoiding fluid overload, using effective antibiotics as soon as possible, blocking the systemic inflammatory response in time, could decrease the incidence of AKI and improve the prognosis of patients.