不同平均动脉压维持水平对感染性休克患儿急性肾损伤的影响

Effects of Maintenance of Different Mean Arterial Pressure on Acute Renal Injury in Children with Septic Shock

目的探讨不同平均动脉压(MAP)维持水平感染性休克患儿急性肾损伤情况及预后情况。方法选取2013年11月至2017年4月我院82例感染性休克患者,参照患者MAP水平分组,将给予血管活性物质后MAP水平(MAPb)<75%平均动脉压平时水平(MAPa)者46例分为A组,75%MAPa≤MAPb<90%MAPa者24例分为B组,90%MAPa≤MAPb<MAPa者12例分为C组,给予各组有创机械通气治疗。统计对比3组治疗后不同时间段(6、12 h)乳酸清除率、急性肾损伤发生情况、不良心血管事件发生情况及病死率。结果治疗后6、12 h时3组乳酸清除率比较,差异均有统计学意义(P<0.05),且B组治疗后不同时间段乳酸清除率高于A组,差异有统计学意义(P<0.05),C组治疗后不同时间段乳酸清除率高于B组,差异有统计学意义(P<0.05);3组血清肌酐、血尿素氮、肾小球滤过率相比,差异有统计学意义(P<0.05);A组、B组、C组急性心肌梗死率[2.17%(1/46)、0.00%(0/24)、0.00%(0/12)]、心动过速率[6.52%(3/46)、8.33%(2/24)、8.33%(1/12)]、房颤率[4.35%(2/46)、4.17%(1/24)、0.00%(0/12)]对比,差异无统计学意义(P>0.05);3组病死率对比,A组30.43%(14/46)与B组20.83%(5/24)、C组16.67%(2/12)间差异无统计学意义(P>0.05)。结论感染性休克患者平均动脉压维持水平对其肾血流指标及肾功能具有明显影响,将其维持于患者平时水平可有效降低急性肾损伤发生风险,且乳酸清除率较高,不会增加不良心血管事件发生率,预后较好,值得推广。

Objective To investigate the status and prognosis of acute renal injury in children with septic shock at different mean arterial pressure（ MAP） maintenance levels. Methods A total of 82 patients with septic shock,admitted in our hospital from November 2013 to April 2017,were divided into 3 groups according to patient MAP levels： group A of 46 cases with MAP level（ MAPb）75% mean arterial pressure level（ MAPa） after administration of vasoactive substances,group B of 24 cases with 75% MAPa≤MAPb90% MAPa,and group C of 12 cases with 90% MAPa≤MAPbMAPa. All groups were treated with invasive mechanical ventilation. The clearance rate of lactic acid,the incidence of acute renal injury and adverse cardiovascular events and mortality at different time periods（ 6 h,12 h） were statistically compared among the three groups after treatment. Results The clearance rate of lactic acid in the three groups 6 h and 12 h after treatment was statistically significant（ P〈0. 05）,and the lactic acid clearance rate in group B was significantly higher than that in group A at different time intervals. The difference was of statistical significance（ P〈0. 05）. The lactic acid clearance rate in group C was significantly higher than that in group B at different time intervals,and the difference was of statistical significance（ P〈0. 05）. The serum creatinine,blood urea nitrogen and glomerular filtration rate were significantly different in the 3 groups. The differences in serum creatinine,blood urea nitrogen and glomerular filtration rate of the three groups were statistically significant（ P〈0. 05）. There were no significant differences in the acute myocardial infarction rate of group A,B and C [2. 17%（ 1/46）,0. 00%（ 0/24）,0. 00%（ 0/12） ],tachycardia rate [6. 52%（ 3/46）,8. 33%（ 2/24）,8. 33%（ 1/12） ],atrial fibrillation rate [（ 4. 35%（ 2/46）,4. 17%（ 1/24）,0. 00%（ 0/12） ]（ P〈0. 05）. There was no significant difference in the mortality rate of the group A（ 30. 43%,14/46）,group B（ 20. 83%,5/24） and group C（ 16. 67%,2/12）（ P〈0. 05）. Conclusion The mean arterial pressure level of patients with septic shock has a significant effect on renal blood flow and renal function. Maintaining it at normal levels can effectively reduce the risk of acute kidney injury,with high lactic acid clearance,low incidence rate of adverse cardiovascular events and good prognosis. Therefore,it is worthy of promotion.