静脉淤血超声评分与脓毒症患者急性肾损伤的相关性研究  

A association study between venous excess ultrasound score and acute kidney injury in patients with sepsis

作　　者：陈工泽 宋佳[2] 陈文玮 胡伟航 来鑫乐 杨凯 龚仕金[2] Chen Gongze;Song Jia;Chen Wenwei;Hu Weihang;Lai Xinle;Yang Kai;Gong Shijin(The Second School of Clinical Medicine,Zhejiang Chinese Medical University,Hangzhou 310053,China;Department of Critical Care Medicine,Zhejiang Hospital,Hangzhou 310013,China)

机构地区：[1]浙江中医药大学第二临床医学院,杭州310053 [2]浙江医院重症医学科,杭州310013

出　　处：《中华危重症医学杂志(电子版)》2024年第6期465-472,共8页Chinese Journal of Critical Care Medicine:Electronic Edition

基　　金：浙江省医药卫生重大科技计划项目(WKJ-ZJ-1601);浙江省医药卫生科研基金项目(2021KY007、2023KY004)。

摘　　要：目的探讨静脉淤血超声评分(VExUS)与脓毒症患者发生急性肾损伤(AKI)的相关性。方法前瞻性研究2022年10月至2023年12月入住浙江医院ICU的54例脓毒症患者,根据住ICU期间是否发生AKI,将所有患者分为AKI组(25例)和非AKI组(29例)。比较两组患者的一般临床资料、血流动力学指标、实验室指标、静脉淤血及心脏超声指标,并采用广义估计方程(GEE)评估VExUS与脓毒症患者发生AKI的相关性。结果AKI组的序贯器官衰竭评估(SOFA)评分、急性病生理学和长期健康评价(APACHE)Ⅱ评分、肌酐、尿素氮、降钙素原(PCT)、脑钠肽(BNP)、72 h液体平衡量均高于非AKI组,而肾小球滤过率(eGFR)、血红蛋白、72 h总尿量均低于非AKI组(P均<0.05)。AKI组第1天[1.0(0.0,2.2)vs.0.0(0.0,1.0)]、第3天[2.0(1.0,3.0)vs.1.0(0.0,2.0)]及第5天[1.0(0.0,2.0)vs.0.0(0.0,1.0)]的VExUS均高于非AKI组(U=2.349、2.441、2.536,P=0.019、0.015、0.011)。VExUS与液体平衡量、外周体征评分、BNP均呈正相关(r=0.314、0.287、0.351,P均<0.05)。GEE分析发现VExUS[比值比=1.661,95%置信区间(1.180,2.339),P=0.004]是影响脓毒症患者AKI发生的独立危险因素。结论VExUS与脓毒症患者住ICU期间AKI的发生相关。床旁超声有助于评估脓毒症患者的静脉淤血情况,指导容量管理策略。Objective To explore the association between venous excess ultrasound score(VExUS)and acute kidney injury(AKI)in patients with sepsis.Methods A prospective study was conducted on 54 sepsis patients admitted to the ICU of Zhejiang Hospital from October 2022 to December 2023.Based on whether AKI occurred during their stay in the ICU,all patients were divided into an AKI group(25 cases)and a non-AKI group(29 cases).The general clinical data,hemodynamic indicators,laboratory indicators,venous congestion,and cardiac ultrasound indicators were compared,and the generalized estimating equation(GEE)was used to evaluate the correlation between VExUS and AKI in sepsis patients.Results The sequential organ failure assessment(SOFA)score,acute physiology and chronic health evaluation(APACHE)II score,creatinine,urea nitrogen,procalcitonin(PCT),brain natriuretic peptide(BNP),and 72-h fluid balance in the AKI group were higher than those in the non-AKI group,while the glomerular filtration rate(eGFR),hemoglobin,and 72-h total urine output were lower(all P<0.05).The VExUS of the AKI group on the first day[1.0(0.0,2.2)vs.0.0(0.0,1.0)],third day[2.0(1.0,3.0)vs.1.0(0.0,2.0)],and fifth day[1.0(0.0,2.0)vs.0.0(0.0,1.0)]was higher than that of the non-AKI group(U=2.349,2.441,2.536;P=0.019,0.015,0.011).VExUS was positively correlated with the fluid balance,peripheral sign score,and BNP(r=0.314,0.287,0.351;all P<0.05).GEE analysis found that VExUS[odds ratio=1.661,95%confidence interval(1.180,2.339),P=0.004]was an independent risk factor for AKI in sepsis patients.Conclusions VExUS is associated with the occurrence of AKI during ICU stay for sepsis patients.Bedside ultrasound is helpful in evaluating venous congestion and guiding volume management strategies.

关 键 词：床旁超声 静脉淤血超声评分 脓毒症 急性肾损伤 

分 类 号：R69[医药卫生—泌尿科学]