血压变异性对低血容量性休克患者急性肾损伤发生的影响  

Impact of blood pressure variability on occurrence of acute kidney injury in patients with hypovolemic shock

作　　者：杨梦 胡秋香[1] 赖晓娟[1] 黄燕梅[1] Yang Meng;Hu Qiuxiang;Lai Xiaojuan;Huang Yanmei(Department of Emergency Medicine,the First Affiliated Hospital,Sun Yat-sen University,Guangzhou 510080,Guangdong Province,China.)

机构地区：[1]中山大学附属第一医院急诊科,广东广州510080

出　　处：《现代临床护理》2024年第12期1-8,共8页Modern Clinical Nursing

基　　金：中山大学附属第一医院临床专科能力建设支持计划项目,项目编号为R70029。

摘　　要：目的探讨血压变异性与低血容量性休克患者急性肾损伤(acute kidney injury,AKI)发生之间的关系,为重症监护室(intensive care unit,ICU)低血容量性休克患者AKI的早期防治提供理论依据。方法分析MIMIC-IV数据库(Medical Information Mart for Intensive CareⅣ,MIMIC-Ⅳ)2008年—2022年中661例低血容量性休克重症患者资料,将收缩压平均真实变异性(systolic blood pressure average real variability,SBP-ARV)、舒张压平均真实变异性(diastolic blood pressure average real variability,DBP-ARV)作为连续变量与分类变量(根据四分位数进行分组),采用单因素和多因素Logistic回归分析SBP-ARV及DBP-ARV与AKI发生的关系。并通过亚组[亚组包括:性别、年龄、序贯器官衰竭评估(sequential organ failure assessment,SOFA)评分、高血压、糖尿病、使用血管升压药物]分析,在对所有协变量进行校正后了解SBP-ARV与AKI发生之间的关系。结果Logistic回归结果显示,校正所有协变量后,SBP-ARV作为一个连续变量与AKI发生独立相关[OR(95%CI):1.05(1.01~1.10),P=0.024],但DBP-ARV与AKI的发生无相关性(P>0.05)。将SBP-ARV按照四分位数离散化后,与Q1组患者相比,Q4组患者AKI发生的风险明显更高[OR(95%CI):1.83(1.04~3.22),P=0.037]。亚组分析显示,SBP-ARV与糖尿病病史之间存在交互作用(P=0.033)。结论在ICU低血容量性休克患者中,较高的SBP-ARV与AKI发生的风险增加相关。Objective To explore the relationship between the variability of blood pressure and the occurrence of acute kidney injury(AKI)in patients with hypovolemic shock so as to provide a theoretical basis for early prediction and prevention of AKI.Methods Clinical data of 661 critically ill patients with hypovolemic shock were acquired from the Medical Information Mart for Intensive CareⅣ(MIMIC-Ⅳ)database from 2008 to 2022.Data were grouped with the quartile division method,with systolic blood pressure average real variability(SBP-ARV)and diastolic blood pressure average real variability(DBP-ARV)as the continuous or categorical variables.Univariate and multivariate logistic regression analyses were used to examine the relationships of SBP-ARV and DBP-ARV with the occurrence of AKI.Additionally,the relationship between SBP-ARV and the occurrence of AKI was further investigated in subgroups of gender,age,sequential organ failure assessment(SOFA),hypertension,diabetes,and the use of vasopressors after correction of all covariates.Results Logistic regression analysis showed that SBP-ARV,a continuous variable,was independently associated with the occurrence of AKI[OR(95%CI):1.05(1.01~1.10),P=0.024].However,DBP-ARV was not significantly related to the occurrence of AKI.When SBP-ARV was grouped by quartile division,Q4 group had a significantly higher risk of AKI[OR(95%CI):1.83(1.04~3.22),P=0.037]compared with that of Q1 group.Analyses across the subgroups revealed that there was an interaction between SBP-ARV and diabetes(P=0.033).Conclusion For ICU patients with hypovolemic shock,SBP-ARV positively associates with the occurrence of AKI.

关 键 词：血压变异性 急性肾损伤 低血容量性休克 回顾性队列研究 MIMIC-IV数据库 

分 类 号：R473.5[医药卫生—护理学]