液体复苏时机对急性肾损伤患者外周血管阻力变化及预后的影响

毛燕芳.液体复苏时机对急性肾损伤患者外周血管阻力变化及预后的影响[J].内科急危重症杂志,2024,30(4):322-326

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DOI：10.11768/nkjwzzzz20240408

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作者	单位	E-mail
毛燕芳	自贡市第一人民医院	emu5465069@163.com

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中文摘要:

摘要目的：探究不同时机进行液体复苏对急性肾损伤（AKI）患者疗效的影响，及外周血管阻力（SVR）变化对预后的影响。方法：收集116例因脓毒症所致AKI患者的临床资料，根据液体复苏时机，将患者分为早期组55例和延迟组61例。比较2组患者复苏前、后不同时间血清肌酐（Scr）、血尿素氮（BUN）、血流动力学指标的变化；比较2组复苏后肾脏替代治疗情况、住院时间、机械通气时间、肾功能恢复率及并发症发生情况；Kaplan-Meier法绘制生存曲线，分析2组28d生存情况；以受试者工作特征（ROC）曲线分析复苏后24h的SVR对患者28d生存情况的预测价值。结果：与复苏前比较，2组患者复苏后24、48、72h及出ICU时的Scr、BUN、SVR均明显降低，心排量（CO）、每搏输出量（SV）明显升高，且早期组的Scr、BUN、SVR明显低于延迟组，CO、SV明显高于延迟组（P均＜0.05）；早期组的ICU住院时间、机械通气时间明显短于延迟组，肾功能恢复率明显高于延迟组（P均＜0.05）；2组并发症总发生率差异无统计学意义（7.27% vs 11.48%，P＞0.05）；早期组28d死亡率明显低于延迟组（30.91% vs 52.46%，P＜0.05）；复苏后24h的SVR预测患者28d死亡的ROC曲线下面积为0.863（95%CI：0.817～0.924，P＜0.001）。结论：早期液体复苏能够快速改善AKI患者的肾功能及SVR，降低患者死亡率。

英文摘要:

Abstract Objective: To investigate the impact of fluid resuscitation at different time points on the therapeutic efficacy of patients with acute kidney injury (AKI) and the influence of changes in systemic vascular resistance (SVR) on prognosis. Methods: Clinical data from 116 patients with AKI caused by sepsis were collected. Patients were divided into an early resuscitation group (55 cases) and a delayed resuscitation group (61 cases) based on the timing of fluid resuscitation. Changes in serum creatinine (Scr), blood urea nitrogen (BUN), and hemodynamic parameters were compared between the two groups before and after resuscitation at different time points. The need for renal replacement therapy, length of hospital stay, duration of mechanical ventilation, renal function recovery rate, and occurrence of complications were also compared between the two groups. The Kaplan-Meier method was used to draw survival curves and analyze 28-day survival in both groups. Receiver operating characteristic (ROC) curves were used to analyze the predictive value of SVR at 24h after resuscitation for 28-day survival. Results: Compared with before resuscitation, Scr, BUN, and SVR were significantly reduced, and cardiac output (CO) and stroke volume (SV) were significantly increased at 24, 48, and 72h after resuscitation and at ICU discharge in both groups. The early resuscitation group had significantly lower Scr, BUN, and SVR levels and significantly higher CO and SV than the delayed resuscitation group (all P<0.05). The early resuscitation group had significantly shorter ICU stay and duration of mechanical ventilation and a significantly higher renal function recovery rate than the delayed resuscitation group (all P<0.05). There was no statistically significant difference in the overall incidence of complications between the two groups (7.27% vs. 11.48%, P> 0.05). The 28-day mortality rate was significantly lower in the early resuscitation group than the delayed resuscitation group (30.91% vs. 52.46%, P<0.05). The area under the ROC curve for predicting 28-day mortality based on SVR at 24 h after resuscitation was 0.863 (95% CI: 0.817-0.924, P< 0.001). Conclusion: Early fluid resuscitation can rapidly improve renal function and SVR in patients with AKI and reduce mortality.