平均动脉压水平与EICU感染性休克患者肾功能关系的回顾性分析

Relationship between mean arterial pressure and renal function in EICU patients with septic shock

目的探讨平均动脉压水平与急诊重症监护室(EICU)感染性休克患者肾功能的关系。方法采用回顾性分析,纳入同济大学附属东方医院胶州医院2018年1月至2020年1月收治的83例EICU感染性休克患者为研究对象,按早期导向治疗后患者平均动脉压(MAP)实际维持水平分为3组。A组(46例):MAP实际维持水平<入EICU前1年内平时MAP水平的75%;B组(25例):入EICU前1年内平时MAP水平的75%<MAP实际维持水平<入EICU前1年内平时MAP水平的90%;C组(12例):入EICU前1年内平时MAP水平的90%<MAP实际维持水平<入EICU前1年内平时MAP水平。记录治疗前后肾主动脉、肾叶间动脉血流动力学指标(舒张期峰值流速、平均流速、血流灌注指数)与肾功能指标(血清肌酐、血尿素氮、血清胱抑素C、血乳酸)的变化,观察治疗后72 h急性肾损伤发生情况。采用t、χ^(2)检验和方差分析进行比较。结果3组治疗后肾主动脉和肾叶间动脉的舒张期峰值流速、平均流速、血流灌注指数较均高于治疗前(均P<0.05);治疗后,A组肾主动脉和肾叶间动脉的舒张期峰值流速、平均流速、血流灌注指数均低于B、C组,B组均低于C组(均P<0.05)。3组治疗后血清肌酐、血尿素氮、血清胱抑素C、血乳酸含量均低于治疗前(均P<0.05);治疗后,A组血清肌酐、血尿素氮、血清胱抑素C、血乳酸含量均显著高于B、C组,B组均高于C组(均P<0.05)。治疗后72 h,A组急性肾损伤发生率为56.52%(26/46),B组为24.00%(6/25),C组为41.67%(5/12),B组急性肾损伤发生率显著低于A组(P<0.05)。结论适度增大EICU感染性休克患者平均动脉压水平能够改善肾脏部位血流动力学,调节肾脏血供及肾功能,并降低急性肾损伤的发生,具有较高的临床应用价值。

Objective To explore the relationship between mean arterial pressure and renal function in emergency intensive care unit(EICU)patients with septic shock.Methods Retrospective analysis was used.Eighty-three EICU patients with septic shock treated at Jiaozhou Hospital,Dongfang Hospital,Tongji University from January 2018 to January 2020 were included as the study objects.The patients were divided into group A(46 cases),group B(25 cases),and group C(12 cases)according to the actual maintenance level of mean arterial pressure(MAP)after early guided therapy.In group A,the actual MAP was maintained<75%of the normal MAP in the one year before entering EICU;in group B,75%of the daily MAP in the one year before entering EICU<the actual maintenance MAP<90%of the daily MAP in the one year before entering the EICU;in group C,90%of the daily MAP in the one year before entering the EICU<the actual maintenance MAP<the daily MAP in the one year before entering the EICU.The changes of renal aorta and interlobar artery hemodynamic indicator(peak diastolic value,mean flow rate,and blood perfusion index)and renal function indicators(serum creatinine,blood urea nitrogen,serum cystatin C,and blood lactic acid)were recorded before and after the treatment.The occurrence of acute renal injury 72 hours after the treatment was observed.The data were compared between the groups by t andχ^(2) tests and analysis of variance.Results The diastolic peak flow rates,mean flow velocities,and perfusion indexes of renal aorta and interlobar artery in the three groups were significantly higher after than before the treatment(all P<0.05).After the treatment,the diastolic peak flow rates,mean flow rates,and blood perfusion indexes of renal aorta and interlobar artery in group A were significantly lower than those in groups B and C(all P<0.05);the diastolic peak flow rates,mean flow rates,and blood perfusion indexes of renal aorta and interlobar artery in group B were significantly lower than those in group C(all P<0.05).The levels of serum creatinine,blood urea nitrogen,serum cystatin C,and blood lactic acid in the three groups were significantly lower after than before the treatment(all P<0.05).After the treatment,the levels of serum creatinine,blood urea nitrogen,serum cystatin C,and blood lactic acid in group A were significantly higher than those in groups B and C(all P<0.05);the levels of serum creatinine,blood urea nitrogen,serum cystatin C,and blood lactic acid in group B were significantly higher than those in group C(all P<0.05).Seventy-two hours after the treatment,the incidence of acute kidney injury was 56.52%(26/46)in group A,was 24.00%(6/25)in group B,and was 41.67%(5/12)in group C;the incidence of acute kidney injury in group A was significantly lower than that in group B(P<0.05).Conclusion Moderate increase of mean arterial pressure in EICU patients with septic shock can improve their renal hemodynamics, regulate their renal bloodsupply and renal function, and reduce the incidence of acute renal injury, so it has high clinical value.