摘要
目的探讨全心舒张末期容积指数（GEDVI）在感染性休克致急性肾损伤（AKI）中的意义。方法回顾性分析2012年3月至2013年5月在沈阳军区总医院急诊监护室确诊感染性休克并接受了脉搏指示连续心排出量（PiCCO）监测的患者61例，按PiCCO监测后第24小时GEDVI值将患者分成两组：低GEDVI组（GEDVI〈700ml／mz，29例）和高GEDVI组（GEDVI／〉700ml／m2，32例）。记录PiCCO监测开始时及第24小时的血流动力学参数、Scr、乳酸（Lac）、AKI发生率及病死率、肾小球滤过率（GFR）基线值、Scr基线值、APACHEⅡ评分、急诊监护室期间及确诊后28d内的病死率，观察GEDVI对感染性休克所致AKI发生率的影响。结果高GEDVI组患者发生AKI26例，低GEDVI组16例，高GEDVI组AKI发病率（81．3％）明显高于低GEDVI组（55．2％）。对两组患者入住急诊监护室期间及确诊后28d内死亡例数进行COX回归模型分析，结果提示AKI及GEDVI与患者死亡无关，尚不能认为AKI及GEDVI为预后的危险因素。结论较高的GEDVI可增加感染性休克患者的AKI发生率，在临床治疗过程中应尽可能避免。
Objective To analyze the significance of global end- diastolic volume index （GEDVI） in acute kidney injury （AKI） after septic shock. Methods A retrospective analysis of 61 patients was performed. The patients were diagnosed of septic shock in emergency ward of Shenyang Military Hospital from 2012 March to 2013 May and were monitored by pulse indicator continuous cardiac output （PiCCO） . The patients were divided into two groups： low GEDVI group （GEDVI 〈 700 ml/m2, 29 cases） and high GEDVI group （GEDVI t〉 700 ml/m2, 32 cases） by evaluating GEDV! of 24 hour after PiCCO. Several physiologic and biochemical indexes were recorded, including the hemodynamic parameters at the beginning and the 24 h of PiCCO monitoring, Scr, BUN, lactic acid, incidence and mortality of AKI, baseline glomerular filtration rate, baseline Scr, APACHE II scores, mortality during the period of emergency ward or within 28 d after the diagnosis. Results A total of 26 cases in high GEDVI group （81.3%） were attacked with AKI, while 16 cases in low GEDVI group （55.2%） were attacked with AKI, the incidence of AKI in high GEDVI group was significantly higher than that in the low GEDVI group. A COX regression analysis of mortality was performed between the patients staying at emergency ward and during 28 d after diagnosis. The results indicated that AKI and GEDVI had no relation with patients＇ death. Therefore, AKI and GEDVI could not be considered as the risk factors for the prognosis. Conclusions High GEDVI can significantly increase the incidence of AKI after septic shock, therefore high GEDVI should be avoided as much as possible in the course of clinical treatment.
出处
《中华肾脏病杂志》
CAS
CSCD
北大核心
2013年第9期650-654,共5页
Chinese Journal of Nephrology
关键词
感染性休克
急性肾损伤
全心舒张末期容积
预后
Septic shock
Acute kidney injury
Global end- diastolic volume index
Prognosis
