摘要
目的评价脉搏指示连续心排出量监测在脓毒症急性肾损伤(AIK)治疗中的临床应用效果。方法选择驻马店市中心医院2013年8月至2016年8月收治的62例脓毒性休克并发AKI患者为研究对象,根据是否应用脉搏指示连续心排出量监测将患者分为对照组(34例)和观察组(28例)。对2组患者液体复苏6、24 h后的复苏液体量、心率(HR)、中心静脉压(CVP)、平均动脉压(MAP)、血管活性药物用量等指标进行观察,比较2组患者的持续肾脏替代治疗时间、日滤过量及治疗7 d后的自主尿量、血肌酐水平及存活率。结果 2组患者液体复苏6 h后的HR、CVP及MAP比较差异均无统计学意义(P>0.05)。液体复苏24 h后,对照组患者的HR与液体复苏6 h后比较差异无统计学意义(P>0.05),CVP和MAP高于液体复苏6 h后(P<0.05);观察组患者的HR低于液体复苏6 h后(P<0.05),MAP高于液体复苏6 h后(P<0.05),CVP与液体复苏6 h后比较差异无统计学意义(P>0.05)。液体复苏24 h后,观察组患者的HR和CVP显著低于对照组(P<0.05),2组患者MAP比较差异无统计学意义(P>0.05)。2组患者液体复苏6 h后的复苏液体量及去甲肾上腺素、多巴酚丁胺用量比较差异无统计学意义(P>0.05)。液体复苏24 h后,观察组患者的复苏液体量、多巴酚丁胺用量显著少于对照组(P<0.05)。观察组患者的持续肾脏替代治疗时间、日滤过量及治疗7 d后血肌酐水平显著低于对照组(P<0.05),而治疗7 d后自主尿量显著高于对照组(P<0.05)。治疗7 d后,对照组患者存活28例,存活率为82.4%(28/34);观察组患者存活25例,存活率为89.3%(25/28);治疗7 d后2组患者存活率比较差异无统计学意义(χ2=0.59,P>0.05)。结论脓毒症AKI患者在液体复苏过程中采用脉搏指示连续心排出量监测能够优化液体管理,促进患者肾功能恢复。
Objective To evaluate the clinical value of pulse indicator continuous cardiac output monitoring in treating acute kidney injury( AKI) due to sepsis. Methods Sixty-two patients with AKI due to sepsis in the Central Hospital of Zhumadian from August 2013 to August 2016 were rolled in and divided into control group( 34 cases) and observation group( 28 cases) according to whether adopted pulse indicator continuous cardiac output monitoring. Six hours and 24 hours after fluid resuscitation,resuscitation fluid volume,heart rate( HR),central venous pressure( CVP),mean arterial pressure( MAP),vasoactive drugs dose of the two groups were observed. Treatment times,daily filtration volume of continuous renal replacement therapy and independent urine volume,serum creatinine level,the survival rate after treating for seven days in the two groups were compared. Results There was no significant difference in the HR,central venous pressure,mean arterial pressure at six hours after fluid resuscitation between the two groups( P > 0. 05). At 24 hours after fluid resuscitation,there was no significant difference in the HR in the control group compared with that at six hours after fluid resuscitation( P > 0. 05),the CVP and MAP were higher than those at six hours after fluid resuscitation( P < 0. 05); the HR in the observation group was lower than that at six hours after fluid resuscitation( P < 0. 05),MAP was higher than that at six hours after fluid resuscitation( P <0. 05),but there was no significant difference in the CVP in the control group compared with that at six hours after fluid resuscitation( P > 0. 05). The HR and CVP at 24 hours after fluid resuscitation in the observation group were lower than those in the control group( P < 0. 05),while there was no no significant difference in the MAP between the two groups( P > 0. 05). There was no significant difference in the fluid resuscitation volume,the dose of noradrenaline and dobutamine after treating for six hours between the two groups( P > 0. 05). Twenty four hours after fluid resuscitation resuscitation fluid volume and dobutamine dose in the observation group were significantly lower than those in the control group( P < 0. 05). The duration of renal replacement therapy,the daily filtration volume and the blood creatinine after treating for seven days in the observation group were significantly lower than those in the control group( P < 0. 05),but the independent urine volume after treating for seven days in the observation group was significantly higher than that in the control group( P < 0. 05). After treating for seven days,there were 28 cases survival,the survival rate was 82. 4%( 28/34),while there were 25 cases survival,the survival rate was89. 3%( 25/28); the difference of survival rate between the two groups was not statistically significant( χ2= 0. 59,P > 0. 05).Conclusion In patients with AKI due to sepsis,pulse indicator continuous cardiac output monitoring can be used to optimize fluid management,and it can improved the renal function.
出处
《新乡医学院学报》
CAS
2018年第3期231-234,共4页
Journal of Xinxiang Medical University
