VExUS评分在脓毒症合并急性肾损伤患者中的应用价值

Application value of venous excess ultrasound score(VExUS Score)in patients with sepsis complicated acute kidney injury

目的评估静脉充盈超声评分(venous excess ultrasound score,VExUS Score)对脓毒症合并急性肾损伤(acute kidney injury,AKI)患者的应用价值,以期降低患者的患病风险及改善预后。方法该研究为单中心前瞻性队列研究,纳入2022年2月至2023年2月入住安徽医科大学第一附属医院急诊重症医学科(emergency intensive care unit,EICU)的合并AKI的脓毒症患者,排除无法行超声检查、下腔静脉(inferior vena cava,IVC)血栓、年龄<18岁及已知肝硬化伴门脉高压的患者。患者接受了超声检查,并进行了连续测定,直到AKI痊愈或患者开始透析。结果共86例患者纳入该研究。年龄(60.43±15.48)岁,男性50例(58.1%)。序贯器官衰竭评估(sequential organ failure assessment,SOFA)评分值为(6.23±1.87)分。38例患者(44.2%)处于AKI 1级,而各有24例患者(27.9%)分别处于AKI 2级和3级。52例患者(60.5%)的VExUS分级为3级。AKI的缓解与VExUS等级的改善显著相关(P=0.003)。同样,VExUS级别的变化与液体平衡之间也存在显著相关性(P=0.005)。中心静脉压(central venous pressure,CVP)、左心室功能和右心室功能与VExUS分级的变化无相关性。结论研究表明,VExUS评分和AKI分期之间存在显著的相关性,随着肾功能的改善,VExUS评分也有所下降。而且VExUS评分能够可靠地显示静脉淤血,并有助于临床决定进行液体清除。

Objective To evaluate the effect of venous excess ultrasound score(VExUS Score)in the acute kidney injury(AKI)in Patients with sepsis,so as to reduce the risk of disease and improve the prognosis of patients.Methods This experiment was a single-center prospective cohort study.Include septic patients with AKI who were admitted to the Department of Emergency Intensive Care Unit of the First Affiliated Hospital of Anhui Medical University from February 2022 to February 2023,Those with inadequate window,inferior vena cava(IVC)thrombus,age<18 years and known case of cirrhosis with portal hypertension were excluded from the study.Patients underwent ultrasound examination with serial determination till AKI resolved or patient is initiated on dialysis.Results Totally 86 patients were enrolled for the study.The mean age was(60.43±15.48)with 50(58.1%)males.Mean sequential organ failure assessment(SOFA)score was(6.23±1.87).38 patients(44.2%)were in AKI stage 1,while 24 patients(27.9%)were in AKI stage 2 and stage 3 each.52 patients(60.5%)had VExUS gradeⅢ.Resolution of AKI injury showed significant correlation with improvement in VExUS grade(p value 0.003).Similarly,there was significant association between changes in VExUS grade and fluid balance(p value 0.005).There was no correlation between central venous pressure(CVP),left ventricular function,and right ventricular function with change in VExUS grade.Conclusions The study shows a significant correlation between the VExUS Score and AKI staging,With improvement in kidney function,there is decline in the VExUS grade as well.Moreover VExUS Score might reliably demonstrate venous congestion and aid in the clinical decision to perform fluid removal.