Nghiên cứu tình hình tổn thương thận cấp ở bệnh nhân nhiễm khuẩn huyết và sốc nhiễm khuẩn tại khoa hồi sức cấp cứu

Nghiên cứu tình hình tổn thương thận cấp ở bệnh nhân nhiễm khuẩn huyết và sốc nhiễm khuẩn tại khoa hồi sức cấp cứu - bệnh viện trung ương huế

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Tác giả: Đông Hoàng, Trọng Ái Quốc Hoàng, Trọng Hanh Hoàng, Bá Thu Mai, Vĩnh Phú Nguyễn, Xuân Khôi Nguyễn, Thị Huyền Trân Trần

Ngôn ngữ: vie

Ký hiệu phân loại: 616.61 *Diseases of kidneys and ureters

Thông tin xuất bản: Tạp chí y học lâm sàng - bệnh viện trung ương huế, 2022

Mô tả vật lý: 134-139

Bộ sưu tập: Metadata

ID: 489082

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Chủ đề

Nhiễm khuẩn huyết là nguyên nhân hàng đầu của tổn thương thận cấp (AKI) và ngược lại tổn thương thận cấp là một tiến triển thường gặp của nhiễm khuẩn huyết. Ngoài liên quan đến nguy cơ tử vong, AKI còn tăng nguy cơ dẫn đến bệnh thận mạn và bệnh thận giai đoạn cuối. Đề tài này nhằm đánh giá tình hình tổn thương thận cấp và một số yếu tố liên quan đến tổn thương thận cấp ở bệnh nhân nhiễm khuẩn huyết và sốc nhiễm khuẩn Phương pháp(:) Bệnh nhân trên 18 tuổi được chẩn đoán xác định nhiễm khuẩn huyết và sốc nhiễm khuẩn tại Khoa Hồi sức cấp cứu, Bệnh viện Trung Ương Huế. Dữ liệu nghiên cứu được lấy từ(:) Bệnh án, hỏi bệnh nhân (nếu bệnh nhân tự trả lời được) hoặc người thân... Khảo sát một số đặc điểm lâm sàng, cận lâm sàng của tổn thương thận cấp ở bệnh nhân nhiễm khuẩn huyết và sốc nhiễm khuẩn Kết quả(:) Nhận thấy một số đặc điểm chung nhóm nghiên cứu(:) nam giới chiếm đa số với 72%, độ tuổi từ 46 - 65 và trên 65 chiếm tỉ lệ cao nhất, điểm SOFA 2 - 4 chiếm tỉ lệ cao với 40%, sốc nhiễm khuẩn chiếm 36% trong số nghiên cứu, tiêu điểm tiêu hóa chiếm tỉ lệ cao nhất với 56%, tiếp theo đó là phổi, thận - tiết niệu, da - mô mềm với tỉ lệ lần lượt 18%, 16%, 5%, 76% bệnh nhân điều trị với 2 loại kháng sinh. Về tổn thương thận cấp, tỉ lệ tổn thương thận cấp là 68%. Về yếu tố liên quan tổn thương thận cấp, có thể thấy các yếu tố liên quan gồm(:) Tuổi bệnh nhân trên 65, bệnh nhân có bệnh lý mạn tính kèm theo và tình trạng sốc nhiễm khuẩn. Tỷ lệ tử vong chiếm tỉ lệ cao với 52%, trong đó tỉ lệ tử vong ở bệnh nhân AKI là 61,7%. Kết luận(:) Bệnh nhân nhiễm khuẩn huyết và sốc nhiễm khuẩn có tỉ lệ diễn tiến AKI cao với 68%. Tiêu điểm nhiễm khuẩn chủ yếu ở nhóm đối tượng nghiên cứu là từ đường tiêu hóa với 56%. Những bệnh nhân lớn tuổi, có bệnh kèm và có tình trạng sốc nhiễm khuẩn có nguy cơ AKI lớn hơn. Tỷ lệ tử vong ở bệnh nhân AKI rất cao với 61,7%.Sepsis is the first reason of acute kidney injury (AKI) and AKI is also the frequent complication of sepsis. Beside relating to mortality rate, patients still carry the risk of developing chronic kidney disease (CKD) and end - stage renal disease. This study aims to investigate the situation of acute kidney injury and the factors which relate to the AKI in patients with sepsis and septic shock. Methods(:) Study subjects included all adults above the age of 18 years admitted to Intensive Care Unit, Hue central hospital with a diagnosis of sepsis and septic shock. Data were collected from the patient's records and through the inteview of patients (if they could answer) or their relatives. Additionally, we reviewed the clinical characteristics and laboratory data of AKI in patients with sepsis and septic shock. Results(:) The percentage of male patients was 72% and the age group 46 - 65 and over 65 accounted for the highest proportion, SOFA scores 2 - 4 took the majority of 40%, septic shock accounted for 36% of the study, the abdominal infectionaccounted for the highest rate with 56%, followed by pulmonary infection, kidney - urinary tract, skin - soft tissue with the percentage of 18%, 16%, 5%, respectively. 76% patients were treated with two types of antibiotics. Regarding the acute kidney injury status, the rate of AKI is 68%. Regarding the factors related to AKI, it can be seen that the relevant factors include(:) Age above 65, comorbidities and septic shock status. The mortality rate is highly 52%, of which the mortality rate in AKI patients is 61.7%. Conclusion(:) Patients with sepsis and septic shock had a high rate of AKI progression with 68%. The main infection in the study group was from the gastrointestinal tract with 56%. Patients who are elderly, have comorbidities, and are in septic shock are at greater risk of AKI. The mortality rate in AKI patients is considerably high with 61.7%.

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