早期的液体平衡与接受连续脏置换治疗的患者的90天死亡率有关
Yusheng Guo1, Junko Kosaka2, Hiroshi Morimatsu1
1Department of Anesthesiology and Resuscitology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences.
Acta medica Okayama
|June 26, 2023
概括
在接受连续置换疗法 (CRRT) 的患者中,积极的液体平衡与更高的90天死亡率有关. 谨慎的流体管理对于改善CRRT患者的治疗结果至关重要.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學.
- 关键护理医学 关键护理医学
- 重症监护室的重症监护室的重症监护室.
背景情况:
- 持续置换疗法 (CRRT) 对于重症患者的液体平衡管理至关重要.
- 在CRRT期间改善患者预后的最佳液体平衡策略尚不清楚.
- 血液动力学状态可能会影响流体管理对结果的影响.
研究的目的:
- 在接受CRRT的患者中调查液体平衡,平均动脉压 (MAP) 和90天死亡率之间的关联.
- 确定正流体平衡是否是CRRT患者死亡率的独立预测因素.
主要方法:
- 单中心回顾性研究 (2018年5月 - 2021年3月).
- 患者在CRRT开始后72小时被分为负 (<0毫升) 和正 (>0毫升) 累积液体平衡组.
- 多变量考克斯回归分析用于评估90天死亡率的独立预测因素.
主要成果:
- 阳性流体平衡组的90天死亡率明显高 (p=0.009).
- 具有阳性液体平衡的患者在CRRT开始时平均动脉压 (MAP) 较低 (p<0.05).
- 经过调整后,72小时的阳性液体平衡独立预测了90天死亡率 (p=0.004).
结论:
- 在接受CRRT的患者中,72小时的阳性液体平衡与90天死亡率的增加有关.
- 这种关联即使在没有冲击,高APACHE II评分,败血症,透析依赖或血管压缩剂使用的子组中仍然显著.
- 在CRRT期间优化流体管理可能对改善患者存活率至关重要.
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