产后合并急性肾功能不全患者的液体管理  

Strategy of fluid therapy for postpartum acute renal failure patients in ICU

作　　者：符加红[1] 赵阳[1] 臧彬[1] 

机构地区：[1]中国医科大学附属盛京医院重症医学科,辽宁沈阳110004

出　　处：《中国急救医学》2015年第1期44-47,共4页Chinese Journal of Critical Care Medicine

摘　　要：目的探讨产后合并急性肾功能不全患者住ICU期间的液体管理策略。方法将治疗成功的产后合并急性肾功能不全患者入住ICU的时间划分为四等份（T1、T2、T3、T4），记录患者从治疗的早期到晚期（T1～T4）各期间内每日的人液量；对比接受和未接受持续肾脏替代治疗（continuous renal replacement therapy，CRRT）患者各期间内的入液量及累积液体平衡。采用相关性分析探讨液体平衡总量与病情危重程度的相关性。结果63例纳入研究，28例接受CRRT，35例行-般治疗。两组患者入住ICU期间液体总平衡均为负；行CRRT患者各期间液体负平衡明显大于未行CRRT患者。接受CRRT患者平均累积液体平衡总量为（-3610±1698）mL，未行CRRT患者平均累积液体平衡总量为（-1820±1030）mL；液体负平衡与APACHEU评分的相关系数为-0．631（P〈0．05）。结论产后合并急性肾功能不全患者常存在液体超负荷，病情越严重，液体潴留量越大，在保证有效循环血量的前提下，液体负平衡是治疗产后合并急性肾功能不全患者的有效手段。Objective To investigate the situation of fluid balance in postpartum acute renal failure patients in ICU, and to explore their fluid strategy. Methods The overall ICU stay duration was divided into quarters deliberately, data about fluid intake and output in each duration were collected. Fluid balance was compared between patients who bad received continuous renal replacement therapy （CRRT） and those who had not. The correlation between overall fluid balance and severity of illness was also detected by correlation analysis. Results A total of 63 cases were included, 28 received CRRT treatment, 35 received conventional treatments without CRRT. Both groups had negative overall fluid balance during ICU stay. The cumulative fluid balance was （ -3610 ± 1698 ）mL for the CRRT group and （ -1820 ±1030）mL for the conventionally treated group, negative fluid balance was more obvious in CRRT group. Total fluid balance correlates with ICU admission APACHE U score as demonstrated by the Pearson coefficient of - 0.631 （ P 〈 0.05 ）. Conclusion Obstetric acute renal failure patients may usually accompany by fluid overload, which correlates with severity of disease. A negative fluid balance strategy may take advantage for postpartum acute renal failure patients in ICU.

关 键 词：急性肾功能不全 产后 液体平衡 持续肾脏替代治疗(CRRT) 

分 类 号：R692.5[医药卫生—泌尿科学]