下腔静脉内径呼吸变异度在感染性休克致急性肾损伤中的作用  

Effects of respiratory variation index of the inferior vena cava internal diameter on acute kidney injury caused by septic shock

作　　者：程涛[1] 张晓霞[1] 彭鹏[1] 

机构地区：[1]新疆医科大学第一附属医院,新疆乌鲁木齐830054

出　　处：《中国急救医学》2016年第1期30-34,共5页Chinese Journal of Critical Care Medicine

摘　　要：目的探究下腔静脉内径呼吸变异度（△ⅡVC）在感染性休克致急性肾损伤（AKI）中的作用。方法回顾性探究2013—10～2015—02新疆医科大学第一附属医院急诊重症监护室（EICU）收治的确诊为感染性休克并分别于液体复苏0h及24h行床旁超声测量下腔静脉内径的成年患者62例，按照液体复苏24h的AIVC分为两组：AIVC〈20％组为L组，AIVC／〉20％组为H组，分别记录液体复苏0h及24h的血流动力学指标、APACHEⅡ评分、血清肌酐（SCr）、血清乳酸（Lac），并记录AKI发生率、EICU病死率及确诊后28d病死率，观察AIVC对EICU感染性休克患者AKI发生率及预后的影响。结果L组心率（HR）、平均动脉压（MAP）、中心静脉氧饱和度（ScvO，）、Lac、外周血管阻力指数（SVRI）、心输出量指数（CI）、全心舒张末期容量（GEDV）在0h和24h时与H组比较差异均无统计学意义（P〉0．05）。L组0h的CVP高于H组[（12．2±5．1）mmHgVS．（9．3±4．1）mgHg，t=2．434，P〈0．05]，24h的CVP亦高于H组[（13．2±3．4）mmHgV8．（9．8±3．6）mgHg，t=3．826，P〈0．05]。L组0h的AIVC低于H组[（51．9±10．3）％VS．（60．7±12．4）％，t=-3．066，P〈0．05]，24h的AIVC亦低于H组[（12．1±4．9）％VS．（31．7±6．6）％，t=-13．291，P〈0．01]。L组患者中25例发生AKI（78．1％），H组患者中16例发生AKI（53．3％），L组AKI发生率明显高于H组（r=4．719，P〈0．05）；所有62例患者中23例在EICU内死亡，其中L组死亡16例（50．0％），H组死亡7例（23．3％），L组EICU内死亡率明显高于H组；L组中有18例（56．3％）于28d内死亡，H组中有11例于28d内死亡（36．7％），L组28d病死率高于H组，但差异无统计学意义（χ^2=4．226，P〉0．05）。结论过低的AIVC增加感染性休克致AKI的发生率、EICU病死率，应注意避免追求过低的AIVC。Objective To explore the effects of respiratory variation index of the inferior vena cava internal diameter （AIVC）on acute renal injury （AKI） caused by septic shock in emergency intensive care unit （EICU）. Method A retrospective study of 62 patients who were diagnosed with septic shock in EICU of The First Teaching Hospital of Xinjiang Medical University from October 1 st 2013 to February 31st 2015 and the AIVC were respectively monitored by bedside ultrasound at the beginning and 24 hour after fluid resuscitation was performed. The cases were assigned into low AIVC group （ △IVC 〈 20% , n = 32）, or high AIVC group （ AIVC ≥20% , n = 30） according to the AIVC of 24 hour after fluid resuscitation. The hemodynamie data, APACHE Ⅱ score, serum creatinine, lactate concentration were performed respectively at the beginning and 24 hour after fluid resuscitation. The incidence and mortality of AKI, the outcome .of these patients in EICU and at Day 28 post - diagnosis were recorded. Results There were 25 cases （78.1%） in low AIVC group attacked with AKI, while 16 cases （53.3%） in high AIVC group were attacked with AKI, the incidence of AKI in low AIVC group was significantly higher than that in the high AIVC group. A total of 23 patients （37.1% ） died in EICU, include 16 cases （50.0%） in low AIVC group and 7 cases （23.3%） in high AIVC group and 18 cases（56.3% ） died at Day 28 post - diagnosis in low AIVC group while 11 cases（36.7% ） in high AIVC group. The emergency intensive care unit mortality in low AIVC group was significantly higher than that in the high AIVC group, but 28 - day mortality there was no statistical difference. Conclusions A low AIVC group may increase and mortality of AKI after septic shock, therefore low △IVC should be avoided in clinical treatment.

关 键 词：下腔静脉内径 呼吸变异度 感染性休克 急性肾损伤(AKI) 血流动力学 液体复苏 

分 类 号：R4[医药卫生—临床医学]