脑卒中患者急性肾损伤与甘露醇和血浆渗透压的关系  

The relationship among acute kidney iujury 、mannitol and plasma osmolality in stroke patients

作　　者：智睿[1] 陈东[1] 丁朝兵[1] 

机构地区：[1]江苏省大丰市人民医院神经内科,224100

出　　处：《中国现代药物应用》2008年第18期6-8,共3页Chinese Journal of Modern Drug Application

摘　　要：目的探讨脑卒中患者急性肾损伤(acute Kidney injury,AKI)与甘露醇和血浆渗透压的关系。方法收集42例脑卒中并发AKI患者,对每例患者进行神经功能评价,记录甘露醇用量,测定入院第2、4天和第7天血肌酐、尿素氮、血糖、血钾、血钠值,计算血肌酐升高绝对值,血浆渗透压变化值。结果血肌酐升高值与神经功能缺损程度评分、血浆渗透压值、血浆渗透压升高值相关(r=0.648,r=0.505,r=0.422,P<0.01),甘露醇用量与血肌酐升高值、第4天血浆渗透压、血浆渗透压升高值不相关(r=0.104,r=-0.19,r=0.059,P>0.05)。非高渗透压血症组(11例):继续使用甘露醇,血肌酐值从(124.66±21.05)mmol/L变化为(125.61±12.73)mmol/L,(t=0.083,P>0.05);高渗透压血症组(31例):血浆渗透压值从(340.19±11.27)mmol/L下降至(315.58±20.96)mmol/L(t=6.45,P<0.01)时,血肌酐值从(139.52±28.10)mmol/L下降为(105.79±39.30)mmol/L(t=5.58,P<0.01),血浆渗透压下降值与血肌酐下降值相关(r=0.772,P<0.01)。结论脑卒中患者AKI与血浆渗透压升高相关,与甘露醇用量不相关,血浆渗透压正常情况下,小剂量甘露醇不会导致AKI。Objective To determine the relationship among acute kidney iujury （AKI）, mannitol and plasma osmolality in stroke patients. Methods The clinical date of 42 stroke patients with AKI was studied . The patient＇ s neurologic function was marked, Scr,plasma osmolality and the dose of mannitol were measured in 2 d,4 d and 7 d after their stroke. Results Increase of Scr was significantly associated with brain injury（r = 0. 648, P 〈 0.01 ） , with increase of plasma osmolality （ r = 0. 422, P 〈 0. 01 ） , with plasma osmolality （ r = 0. 505, P 〈 0.01 ） ; Dose of mannitol was not significantly associated with increase of Scr （ r = 0. 104, P 〉 0.05 ）, with increase of plasma osmolality （ r = 0. 059, ,P 〉 0. 05 ） and with plasma osmolality （ r = -0. 19, P 〉 0.05 ）. The patients of plasma osmolality 〈 320 mOsm/L （ 11 cases） went to use mannitol , Scr was （ 124. 66 ± 21.05 ） mmol/L in 4 d, （ 125.61 ± 12.73 ） mmol/L in 7 d （ t = 0. 083, P 〉 0. 05 ）. When plasma osmolality was from （340. 19 ± 11.27 ） mOsm/L down to （315.58 ± 20. 96） mmol/L （ t = 5.58, P 〈 0.01 ）, Scr was from （ 139. 52 ± 28.10） mmol/L down to （ 105.79 ± 39. 30） mmol/L （ t = 5.58, P 〈 0. 01 ） in patients of plasme Patients ≥ 320 mOsm/L （ 31 cases） . Conclusion When plasma osmolality is ≤ 320 mOsm/L, mannitol doesn＇t induce AKI.

关 键 词：脑卒中 急性肾损伤 甘露醇 血浆渗透压 

分 类 号：R743.3[医药卫生—神经病学与精神病学]