肾灌注压估算值对严重多发伤患者发生急性肾损伤的预测价值  

The predictive value of estimated renal perfusion pressure in acute kidney injury of severe multiple trauma patients

作　　者：漆靖 孙传政[1] 刘怀政[1] 周柯夫[1] 戴哲人 唐亦舒 Qi Jing;Sun Chuanzheng;Liu Huaizheng;Zhou Kefu;Dai Zheren;Tang Yishu(Department of Emergency Medicine,the Third Xiangya Hospital,Central South University,Changsha,410013,China)

机构地区：[1]中南大学湘雅三医院急诊科,长沙410013

出　　处：《中华急诊医学杂志》2021年第8期968-972,共5页Chinese Journal of Emergency Medicine

基　　金：国家自然科学基金面上项目(82070597);湖南省自然科学基金面上项目(2019JJ40466);湖南省自然科学基金面上项目(2019JJ40467)。

摘　　要：目的探讨肾灌注压估算值(eRPP)对严重多发伤患者发生急性肾损伤的预测价值。方法回顾性分析中南大学湘雅三医院创伤中心严重多发伤患者的临床资料,根据患者入院72 h内是否发生急性肾损伤(AKI)分为AKI组与非AKI组。收集两组患者的一般资料及ISS、SOFA,APECHEⅡ评分,上肢动脉血压(MAP)、中心静脉压(CVP)联合腹腔内力压(IAP)等,并通过计算得到患者肾脏灌注压估算值(eRPP)。比较两组组间相关指标差异情况,Logistic回归分析患者发生AKI的独立预测因子,ROC曲线分析相应指标的预测价值。结果共173例严重多发伤患者入组,AKI组患者血清白蛋白[(32.21±5.20)g/L vs.(34.83±4.20)g/L,P=0.001]及24 h尿量[(711.90±241.38)mL vs.(1101.21±509.86)mL,P<0.001]低于非AKI组,而血清乳酸水平[(2.80±0.96)mmol/L vs.(1.89±0.63)mmol/L,P<0.001]、ISS[(29.05±5.91)vs.(22.17±4.02),P<0.001]、APECHEⅡ[(38.84±21.47)vs.(31.45±18.24),P=0.03]、SOFA评分[(5.26±2.08)vs(3.14±1.34),P<0.001]及病死率(9.52%vs.2.29%,P=0.04)均显著高于非AKI组,ICU住院时间也较非AKI组显著延长[(8.43±6.46)d vs.(6.42±3.78)d,P=0.01]。患者入院后6 h、12 h及24 h CVP及eRPP与AKI的发生显著相关,Logistic回归分析显示入院24 h尿量、CVP与eRPP为患者发生AKI的独立预测影响因子(P<0.05),相较于尿量及CVP,eRPP更具有预测价值。结论入院24 h的eRPP值可能为严重多发伤患者发生AKI的最适合的独立预测因子。Objective To investigate the predictive value of estimated renal perfusion pressure(eRPP)for acute kidney injury(AKI)in severe multiple trauma patients.Methods Severe multiple trauma patients were collected based on the inclusion criteria and exclusion criteria from the Trauma Center,the Third Xiangya Hospital,Central South University.Subsequently,patients were divided into the AKI group and non-AKI group according to the occurrence of AKI during 72 h admission to hospital.Further clinical information,ISS score,SOFA score,APACHE Ⅱ score,mean arterial pressure(MAP),central venous pressure(CVP)and intra-abdominal pressure(IAP)were collected,and eRPP were calculated.Additionally,the differences of parameters in the AKI group and non-AKI group were analyzed and logistic regression analysis was performed to identify the independent predicted risk factors for AKI.Finally,ROC curve was conducted to identify specifi city,sensibility and best cut-off point.Results A total of 173 severe multiple trauma patients were fi nally analyzed.Compared with the non-AKI group,the serum albumin[(32.21±5.20)g/L vs.(34.83±4.20)g/L,P=0.001]and 24 h urine output[(711.90±241.38)mL vs.(1101.21±509.86)mL,P=0.001]were signifi cantly lower and serum lactate[(2.80±0.96)mmol/L vs.(1.89±0.63)mmol/L,P<0.001],ISS score[(29.05±5.91)vs.(22.17±4.02),P<0.001],APACHE Ⅱ score[(38.84±21.47)vs.(31.45±18.24),P<0.001]and SOFA score[(5.26±2.08)vs.(3.14±1.34),P<0.001],in-hospital mortality(9.52%vs.2.29%,P=0.038),and ICU stay[(8.43±6.46)d vs.(6.42±3.78)d,P=0.01]were signifi cantly higher in the AKI group.Moreover,6,12 and 24 h of CVP and eRPP after admission were associated with the incidence of AKI.Logistic regression analysis showed that 24 h urine output,CVP and eRPP were the independent predictive factors(P<0.05)and 24 h of eRPP after admission applied a better predictive value of the incidence in AKI.Conclusions 24 h of eRPP might be the most suitable independent predictive factor for AKI in severe multiple trauma patients.

关 键 词：回顾性研究 严重多发伤 急性肾损伤 预测因子 中心静脉压 动脉血压 腹内压 肾灌注压 

分 类 号：R692[医药卫生—泌尿科学] R641[医药卫生—外科学]