摘要
目的探讨静脉负荷超声(VExUS)评分与急性心力衰竭患者急性肾损伤(AKI)的相关性。方法回顾性选取2023年7月至2024年5月平湖市第一人民医院重症监护病房(ICU)收治的48例急性心力衰竭合并AKI患者为研究对象。连续记录患者的AKI分期、血肌酐、尿量、每日液体平衡量、VExUS评分等指标。在患者入院第3天,根据VExUS评分变化分为改善组、不变组和恶化组,比较3组患者AKI缓解情况、液体平衡情况、中心静脉压(CVP)、左心室射血分数(LVEF)、液体超负荷临床体征等指标的差异,采用Kendall相关性分析VExUS评分改善与AKI缓解和液体负平衡的相关性。结果48例患者中,年龄(76.54±12.07)岁,急性生理学和慢性健康状况评价Ⅱ评分(17.88±2.96)分。患者处于AKI 1期28例(58.33%),AKI 2期12例(25.00%),AKI 3期8例(16.67%)。VExUS评分≥1分40例(83.33%)。不同VExUS分组患者AKI缓解情况、液体平衡情况比较差异均有统计学意义(均P<0.05),而CVP、LVEF、液体超负荷临床体征比较差异均无统计学意义(均P>0.05)。Kendall相关性分析显示,VExUS评分改善与AKI缓解和液体负平衡呈正相关(r=0.291、0.357,均P<0.05)。结论VExUS评分可能有助于量化静脉充血的严重程度,与患者AKI的缓解密切相关,可指导急性心力衰竭患者的液体管理。
Objective To investigate the correlation between the venous excess ultrasound(VExUS)score and acute kidney injury(AKI)in patients with acute heart failure(AHF).Methods A total of 48 AHF patients complicated with AKI,admitted to the intensive care unit(ICU)of Pinghu First People's Hospital from July 2023 to May 2024,were retrospectively enrolled.Parameters including AKI stage,serum creatinine,urine output,daily fluid balance,and VExUS score were recorded continuously.On day 3 after admission,patients were categorized into improvement,no-change,or deterioration groups based on changes in VExUS score.Differences in AKI remission,fluid balance,central venous pressure(CVP),left ventricular ejection fraction(LVEF),and clinical signs of fluid overload were compared among the groups.Kendall correlation analysis was used to assess the correlation between VExUS score improvement and AKI remission as well as negative fluid balance.Results Among the 48 patients,the mean age was(76.54±12.07)years,and the mean Acute Physiology and Chronic Health EvaluationⅡscore was 17.88±2.96.There were 28 cases(58.33%)in AKI stage 1,12(25.00%)in stage 2,and 8(16.67%)in stage 3.A total of 40 patients(83.33%)had a VExUS score≥1.Statistically significant differences were observed in AKI remission and fluid balance among the different VExUS groups(all P<0.05),while no significant differences were found in CVP,LVEF,or clinical signs of fluid overload(all P>0.05).Kendall correlation analysis indicated that improvement in VExUS score was positively correlated with AKI remission and negative fluid balance(r=0.291 and 0.357,respectively;both P<0.05).Conclusion The VExUS score may help quantify the severity of venous congestion,is closely associated with AKI remission,and can guide fluid management in patients with AHF.
作者
钟林
汪敏
盛菊萍
沈玲
姜建平
ZHONG Lin;WANG Min;SHENG Juping;SHEN Ling;JIANG Jianping(Department of Critical Care Medicine,Pinghu First People's Hospital,Pinghu 314200,China)
出处
《浙江医学》
2026年第2期173-176,181,共5页
Zhejiang Medical Journal
基金
浙江省教育厅一般科研项目(Y202456473)
平湖市科技计划项目(社发类13号)。
关键词
静脉负荷超声
急性心力衰竭
急性肾损伤
液体管理
Venous excess ultrasound
Acute heart failure
Acute kidney injury
Fluid management
