重症患者住院期间血压变异性与急性肾损伤的相关性分析  

Relationship between Blood Pressure Variability and In-Hospital Acute Kidney Injury in Critically Ill Patients

作　　者：侯陈玮 李雅坤 梁影 陈书弘 李哲[1] 黑飞龙[1,2] HOU Chenwei;LI Yakun;LIANG Ying;CHEN Shuhong;LI Zhe;HEI Feilong(Department of Cardiopulmonary Bypass,Fuwai Hospital,Chinese Academy of Medical Science&Peking Union Medical College,Bejing 100037,China;Center for Cardiac Intensive Care,Bejing Anzhen Hospital,Capital Medical University Beijing 100029,China)

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外医院体外循环中心,北京市100037 [2]首都医科大学附属北京安贞医院心脏外科危重症中心体外循环及机械循环辅助科,北京市100029

出　　处：《中国分子心脏病学杂志》2022年第3期4653-4659,共7页Molecular Cardiology of China

摘　　要：目的探讨重症患者住院期间血压变异性与急性肾损伤之间的关系,为患者的个体化血压调控提供目标和方向。方法通过筛选重症监护多参数智能监测数据库Ⅲ中的人群进行研究,计算患者入重症监护室后第1天收缩压、舒张压、平均动脉压的变异性参数——平均真实变异性。使用限制性立方样条函数探索变异性参数与结局的非线性关系,多因素Logistic回归评估住院期间血压变异性与急性肾损伤之间的关系。结果共纳入4654例患者,2571例患者发生急性肾损伤,其中1期1263例,2期1128例,3期180例。曲线拟合显示血压变异性与住院期间急性肾损伤之间不存在明显的非线性关系,Logistic回归方程在调整其他危险因素后显示,高水平平均动脉压的血压变异参数与急性肾损伤(OR:1.17,95%CI:1.03~1.34,P=0.017)相关,且在亚组分析中保持稳定。结论血压变异性的增加是重症患者住院期间发生急性肾损伤的独立危险因素。Objective To explore the relationship between blood pressure variability and the incidence of acute kidney injury in critically ill patients during hospitalization,so as to provide objectives and directions for individualized blood pressure regulation.Methods The Medical Information Mark for Intensive CareⅢ(MIMIC-Ⅲ)database was used for study.The average real variability of systolic blood pressure,diastolic blood pressure and mean arterial pressure in the first 24 hours after admission to intensive care unit(ICU)were recorded.Restrictive cubic spline function was used to explore the nonlinear relationship between variability parameters and outcomes,and multivariate logistic regression model was used to evaluate the relationship between blood pressure variability and the incidence of acute kidney injury during hospitalization.Results A total of 4654 patients were included in this study.2571 patients had acute kidney injury,including 1263 stage 1,1128 stage 2 and 180 stage 3.Curve fitting showed that there was no obvious nonlinear relationship between blood pressure variability and acute kidney injury during hospitalization.Logistic regression equation showed that after adjusting other risk factors,the parameter of blood pressure variability at high levels of mean arterial pressure was correlated with the incidence of acute kidney injury(OR:1.17,95%CI:1.03-1.34,P=0.017),and remained stable in subgroup analysis with age,admission type,SOFA score,hypertension and diabetes as grouping variables.Conclusion The increase of blood pressure variability is an independent risk factor for acute kidney injury during hospitalization.High levels of mean arterial pressure and blood pressure variability increase the risk of acute kidney injury in critically ill patients.

关 键 词：重症患者 血压变异性 急性肾损伤 

分 类 号：R692[医药卫生—泌尿科学]