液体管理对心源性休克患者急性肾损伤的影响

Effects of fluid management on acute renal injury in patients with cardiogenic shock

目的评价液体管理对心源性休克（cardiogenicshock，CS）患者急性肾损伤（acutekidneyinjury，AKI）发生率的影响。方法选取171例在我院ICU进行液体复苏的心源性休克患者，其中79例患者（PiCCO组，n=79）采用PiCCO指导液体复苏，92例患者（常规组，n=92）采用常规中心静脉压监测方法指导液体复苏。通过常规测定尿量和血清肌酐来连续监测患者肾功能，并比较两组患者复苏液体量与AKI的发生率。结果PiCCO组患者复苏累计液体量显著高于常规组[（5450±1449）mLVS．（4386±1296）mL，P=0．008]。共有71（41．5％）例患者诊断为AKI，PiCCO组AKI患者比例显著低于常规组[10（12．7％）vs．61（66．3％），P〈0．001]。PiCCO组有风险期、损伤期与衰竭期患者各7、3与0例，而常规组有各36、22与3例。常规组风险期与损伤期AKI患者比例显著高于PiCCO组，差异有统计学意义（P〈0．001）。结论由体积[血管外肺水指数（ELWI），肺毛细血管渗透性指数（GEDI）]和动脉波形衍生的变量[（脉压变异（PPV），每搏量变异（SVV）]指导的容量治疗，可以减少心源性休克患者的AKI发生率。

Objective To evaluate the effect of fluid management on the incidence of acute kidney injury （AKI） in patients with eardiogenic shock. Methods A total of 171 patients with cardiogenic shock who underwent fluid resuscitation in our hospital were included. PiCCO - guided fluid resuscitation was used in 79 patients （ PiCCO group, n = 79）. 92 patients （ routine group, n = 92） underwent routine central venous pressure monitoring to guide fluid resuscitation. Renal function was continuously monitored by routine urine volume measurement and serum creatinine, and the incidence of AKI was compared between the two groups. Results The cumulative fluid volume in the PiCCO group was significantly higher than that in the conventional group E （5450 ± 1449） mL vs. （4386 ± 1296） mL, P =0. 008]. A total of 71 （41.5%） patients were diagnosed with AKI. The proportion of patients with AKI in the PiCCO group was significantly lower than that in the conventional group [ 10 （ 12.7% ） vs. 61 （66.3%）, P〈0. 001]. There were 7, 3, and 0 patients in the PiCCO group at risk, in the injury and failure phases, and 36, 22, and 3 in the conventional group. The proportion of AKI patients in risk and injury in the conventional group was significantly higher than that in PiCCO group （ P 〈 0. 001 ）. Conclusion Volumetric （ELWI, GEDI ） and arterial waveform- derived variables （PPV, SVV ） guided capacity therapy can reduce the incidence of AKI in patients with eardiogenic shock.