最佳尿量阈值指导急性胰腺炎患者的早期液体治疗  

Early fl uid therapy guided by optimal urine output threshold in patients with acute pancreatitis

作　　者：张云[1,2] 宁巧 王佳 黄小菲[1,2] 秦凤霞 倪海滨[1,2] Zhang Yun;Ning Qiao;Wang Jia;Huang Xiaofei;Qin Fengxia;Ni Haibin(Deparment of Emergency,Affi liated Hospital of Integrated Traditional Chinese and western Medicine,Nanjing University of Chinese Medicine,Nanjing 210000,Jiangsu,China;Jiangsu Province Academy of Traditional Chinese Medicine,Nanjing 210000,Jiangsu,China)

机构地区：[1]南京中医药大学附属中西医结合医院急诊科,南京210000 [2]江苏省中医药研究院,南京210000

出　　处：《中华急诊医学杂志》2022年第10期1384-1388,共5页Chinese Journal of Emergency Medicine

基　　金：江苏省卫健委项目(ZDB2020032)。

摘　　要：目的探讨急性胰腺炎(acute pancreatitis,AP)患者发生急性肾损伤(acute kidney injury,AKI)的尿量阈值,指导早期液体治疗。方法提取美国重症监护医学信息数据库Ⅳ(medical information mart for intensive careⅣ,MIMIC-Ⅳ)中AP患者的临床资料,计算24 h尿率[24 hour urine output·kg^(-1)·24 hour^(-1),24-UR mL/(kg·h)]和48 h尿率[48 hour urine output·kg^(-1)·48 hour^(-1),48-UR mL/(kg·h)],根据患者7 d内是否发生急性肾损伤(AKI within 7 days,7-AKI)分为7-AKI组和非7-AKI组,绘制受试者工作特征(receiver operating characteristic,ROC)曲线,评估24-UR和48-UR对AP患者7-AKI发生的预测价值,根据ROC曲线得出的最佳截断值分别对24-UR与48-UR分组,采用逻辑回归分析7-AKI的危险因素,绘制Kaplan-Meier(KM)生存曲线分析24-UR和48-UR对AP患者住院病死率的影响。结果共纳入713例AP患者,ROC曲线分析结果显示,24-UR预测AP患者7-AKI的ROC曲线下面积(area under the ROC curve,AUC)为0.76,依据最大约登指数计算出的24-UR截断值为0.795 mL/(kg·h),48-UR的AUC为0.78,48-UR截断值为0.975 mL/(kg·h)。逻辑回归分析结果显示,与24-UR>0.795 mL/(kg·h)相比,24-UR≤0.795 mL/(kg·h)的是7-AKI的独立危险因素(OR:4.22,95%CI:1.5~11.85,P=0.006),同样,与48-UR>0.975 mL/(kg·h)相比,48-UR≤0.975 mL/(kg·h)的是7-AKI的独立危险因素(OR:3.75,95%CI:1.45~9.72,P=0.007);KM生存曲线显示高24-UR组住院生存率高于低24-UR组。结论24-UR可用于指导AP患者早期液体治疗。Objective To investigate the urine output threshold of acute kidney injury in patients with acute pancreatitis(AP)and to guide early fl uid therapy.Methods The clinical data of AP patients from Medical Information Mart for Intensive CareⅣ(MIMIC-Ⅳ)were collected.The 24-h urine output rate[24-h urine output·kg^(-1)·24-h-1,24-UR mL/(kg·h)]and 48-h urine output rate[48-h urine output·kg^(-1)·48-h-1,48-UR mL/(kg·h)]were calculated,and according to the occurrence of acute kidney injury within 7 days(7-AKI),AP patients were divided into the 7-AKI group and non-7-AKI group.The receiver operating characteristic(ROC)curve was drawn to evaluate the predictive value of 24-UR and 48-UR on 7-AKI in AP patients.24-UR and 48-UR were grouped according to the optimal cut-off value obtained from the ROC curve.Logistic regression was used to analyze the risk factors of 7-AKI,and Kaplan-Meier(KM)survival curve was drawn to analyze the effect of 24-UR and 48-UR on in-hospital mortality of AP patients.Results A total of 713 AP patients were included,ROC curve analysis showed that the area under the ROC curve(AUC)of 24-UR in predicting 7-AKI in AP patients was 0.76.Based on the maximum Youden index,the cut-off value of 24-UR was 0.795 mL/(kg·h),and the AUC of 48-UR was 0.78 and the cut-off value of 48-UR was 0.975 mL/(kg·h).Logistic regression analysis showed that 24-UR≤0.795 mL/(kg·h)was an independent risk factor for 7-AKI compared with 24-UR>0.795 mL/(kg·h)(OR:4.22,95%CI:1.50-11.85,P=0.006).Similarly,compared with 48-UR>0.975 mL/(kg·h),48-UR0.975 mL/(kg·h)was an independent risk factor for 7-AKI(OR:3.75,95%CI:1.45-9.72,P=0.007).The KM survival curve showed that the cumulative in-hospital survival rate in the high 24-UR group was higher than that in the low 24-UR group.Conclusions 24-UR can be used to guide early fl uid therapy in AP patients.

关 键 词：急性胰腺炎 尿量阈值 液体治疗 

分 类 号：R576[医药卫生—消化系统]