下腔静脉扩张指数在脓毒症休克性急性肾损伤中的作用

Effects of the distensibility index of inferior vena cava on acute kidney injury caused by septic shock

目的探讨下腔静脉扩张指数在脓毒症休克性急性肾损伤（AKI）中的作用。方法回顾性研究2013年10月至2015年2月新疆医科大学第一附属医院EICU收治的确诊为脓毒症休克且已于液体复苏开始即刻及其后24h时应用床旁超声测量了下腔静脉吸气及呼气时管径的成年患者62例，按照自液体复苏后24h时下腔静脉扩张指数（dIVC），dIVC≥9％组为H组，dIVC〈9％组为L组，收集液体复苏即刻及其后24h时的血肌酐（Scr）值、血流动力学监测指标、APACHEⅡ评分、血清乳酸（Lac）水平并统计AKI发生率、EICU内病死率及其确诊后28d病死率，观察dIVC对EICU内脓毒症休克性急性。肾损伤的发生率及对其预后所产生的影响。结果所有患者中共有41例发生AKI，其中L组和H组分别为26例、15例，L组AKI发生率高于H组，其差异具有统计学意义（x^2=5．047，P〈0．05）；所有患者中有23例在EICU内发生死亡，其中L组为16例（48．5％），H组为7例（24．1％），L组明显高于H组（x^2=3．921，P〈0．05）；两组患者确诊28d后共死亡29例，L组和H组分别死亡18例（54．5％）、11例（37．9％），L组患者病死率虽高于H组，但差异无统计学意义（x^2=1．711，P〉0．05）。确诊28d后死亡的患者中，发生AKI患者23例，而未发生AKI患者有6例，两组间差异有统计学意义（x^2=4．226，P〈0．05）。结论脓毒症休克性AKI可加重脓毒症休克患者的不良预后，而过低的dIVC町增加脓毒症休克性AKI的发生风险，进而加重其不良预后。所以，在脓毒症休克患者的液体复苏过程中应注意避免追求过低的dIVC，以免加重其不良预后。

Objective To explore the effects of the distensibility index of inferior vena cava （dlVC） on acute renal injury （AKI） caused by septic shock. Methods A total of 62 patients with septic shock admitted into EICU in The First Teaching Hospital of Xinjiang Medical University from October 2013 to February 2015 were enrolled. The dlVC were monitored by bedside ultrasound at the onset of septic shock and 24 hours after fluid resuscitation were retrospectively studied. The cases were assigned into two groups as per the the dlVC at 24 hours after fluid resuscitation. There were 33 cases in low dlVC group （dlVC 〈9% ） and 29 cases in high dlVC group （dlVC≥ 9% ）. Their APACHE Ⅱ score, hemodynamie data, serum ereatinine, lactate concentration were recorded respectively at the onset of septic shock and 24 hours after fluid resuscitation. The incidence and mortality of AKI, the outcome of these patients in EICU and at mortality rate in 28 days after definite diagnosis made were recorded. Results （1）The incidences of AKI were 78.8 % （26/33） and 51.7 % （15/29） in low and high dlVC groups respectively, and the incidence of AKI in low dlVC group was significantly higher than that in the high dlVC group （ x^2 = 5. 047, P 〈 0. 05） ; （2）Of them, 16 cases （48.5%） died in EICU in low dlVC group and 7 cases （24. 1% ） in high dlVC group, and the mortality in low dlVC group was significantly higher than that in the high dlVC group （ x^2 = 3. 921, P 〈 0. 05） ; （3）Of them, 18 cases （54. 5% ） died within 28 days after definite diagnosis confirmed in low dlVC group while 11 cases （37.9%） in high dlVC group, but there was no difference between two groups （ x^2 = 1. 711, P 〉 0. 05 ）. Conclusions A low dlVC could increase the incidence and mortality of AKI in septic shock, and the extremely low dlVC should be prevented in clinical treatment.