中心静脉压在感染性休克致急性肾损伤中的作用  

Effect of central venous pressure on septic shock induced acute kidney injury

作　　者：王彦军[1] 高蕊[2] 贾文元[1] 张松涛[1] 赵威[1] 刘卓 尹文[1] WANG Yan-jun GAO Rui JIA Wen-yuan ZHANG Song-tao ZHAO Wei LIU Zhuo YIN Wenl(Department of Emergency, Xijing Hospital, Fourth Military Medical University, Xi＇an 710042, China Department of Respiration,Xi＇an Children＇s Hospital,Xi＇an 710043 ,China Department of Neurosurgery, Xidian Group Hospital, Xi＇an 710077, China)

机构地区：[1]第四军医大学西京医院急诊科,西安710032 [2]西安市儿童医院,西安710043 [3]西安市西电医院,西安710077

出　　处：《创伤外科杂志》2017年第8期566-569,共4页Journal of Traumatic Surgery

摘　　要：目的分析中心静脉压在感染性休克致急性肾损伤(AKI)中的作用。方法回顾性分析2012年1月-2015年1月在西京医院急诊科确诊的感染性休克患者138例,经24h血流动力学监测后根据中心静脉压(CVP)分成两组:CVP 6~10mmHg(63例)组和CVP 11~14mmHg(75例)组。采用每搏连续无创血压监测系统(CNAP)监测患者血流动力学指标、AKI发病率和死亡率、乳酸等生理生化指标。统计分析CVP与感染性休克致AKI的关联。结果两组患者除CVP不同外(P<0.01),其他生理指标(心率、平均动脉压、血氧饱和度等)无统计学意义。低CVP组中AKI发病率为49.2%(31例),高CVP组中AKI发病率为78.7%(59例),高CVP组AKI发病率显著高于低CVP组(χ~2=8.12,P<0.05)。其中高CVP组的AKIⅢ期患者(42例)显著多于低CVP组的AKIⅡ期患者(13例),χ~2=8.12,P<0.05。在两组患者治疗过程中,去甲肾上腺素和多巴酚丁胺的使用没有明显差别。高CVP组中死亡率为48.0%(36例),显著高于低CVP组的死亡率30.2%(19例,χ~2=3.93,P<0.05)。相关分析表明,CVP和感染性休克致AKI死亡率呈正相关(r=0.80,P<0.01)。结论中心静脉压处于较高水平状态增加感染性休克致急性肾损伤的发病率和死亡率。降低CVP可能会降低感染性休克致AKI的死亡率。Objective To explore the correlation between central venous pressure （CVP） on septic shock induced by acute kidney injury （ AKI ）. Methods Patients diagnosed with septic shock admitted to emergency de- partment of Xijing Hospital （Xi＇an） between Jan. 2012 and Jan. 2015 were retrospectively studied. A total of 138 patients with septic shock were included, and they were divided into low central venous pressure （ LCVP ） group and high central venous pressure （HCVP） group. The death rate, incidence of AKI, and hemodynamics indexes were measured. The correlation between CVP and AKI was analyzed by SPSS. Results While there was a significant difference in the CVP between the two groups （ P 〈 0.01 ） , other physiological and biochemical indexes （ age, Scr） were not significantly different. The morbidity of AKI was higher in HCVP group （ n = 59 ） than LCVP group （ 31 ） , X2 = 8.12,P 〈 0.05. Moreover, the number of AKIN3 was significantly more in HCVP group （ n = 42） than LCVP group I n = 13, X2 = 8.12, P 〈 0.05 ）. During the treatment process, there was no significant difference in the appli- cation of norepinephring and dobutamine. The death rate was also higher in HCVP group （ 48.0% ） than LCVP group（ 30.2% , X2 =3.93 ,P 〈0.05）. Correlation analysis showed that CVP and the death rate of AKI were posi- tively correlated （ r = 0. 80,P 〈 0.01 ）. Conclusion High CVP increases the morbidity and mortality of AKI. De- creased CVP may reduce mortality in septic shock-induced AKI.

关 键 词：肾损伤 中心静脉压 休克 

分 类 号：R631.4[医药卫生—外科学]