在开放胸腔腹腔大动脉修复后检测第三阶段急性损伤的NephroCheck床边系统
Panagiotis Doukas1, Jan Paul Frese2, Thorsten Eierhoff3
1Department of Vascular and Endovascular Surgery, University Hospital Aachen, RWTH Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany. pdoukas@ukaachen.de.
Scientific reports
|July 9, 2023
概括
在开放性大动脉修复后24小时内,NephroCheck系统可靠地检测到第三阶段急性损伤 (AKI). 早期发现AKI对于管理这种常见并发症和改善患者的治疗结果至关重要.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 心血管外科心血管外科
- 临界护理医学 临界护理医学
背景情况:
- 急性损伤 (AKI) 是复杂的大动脉手术后的常见和严重并发症,显著增加死亡率和发病率.
- 目前用于早期和特定AKI检测的方法不足,强调需要改进的诊断工具.
研究的目的:
- 评估NephroCheck床边系统的诊断准确性,用于在接受开放性大动脉手术的患者中识别3期AKI.
- 评估AKI与不良临床结果之间的相关性,包括死亡率和器官功能障碍.
主要方法:
- 一项前性的多中心观察性研究,包括45名接受开放胸腔腹腔大动脉修复的患者.
- 在多个时间点收集尿液样本,以使用NephroCheck系统计算AKI风险 (AKIRisk-Index).
- AKI分类遵循KDIGO标准,并使用后勤回归分析了贡献因素. 预测能力通过ROCAUC进行评估.
主要成果:
- 在45名患者中,31名 (68.8%) 患有AKI,其中21名 (44.9%) 进展到需要透析的第三阶段AKI.
- AKI与增加的住院死亡率,呼吸道并发症,败血症和多器官功能障碍综合征显著相关.
- 该AKIRisk-Index显示了可靠的诊断准确性,用于第3阶段的AKI,从手术后24小时开始 (ROCAUC: .8056,p=.001).
结论:
- NephroCheck系统提供了足够的诊断准确度,可以在开放性大动脉修复后的24小时内检测有3期AKI风险的患者.
- 早期识别使用NephroCheck的高风险患者可能会引导及时干预,并改善术后AKI的管理策略.
相关概念视频
01:30Acute Kidney Injury IV: Diagnostic Studies and Prevention
37
Accurate diagnosis and effective prevention are critical in managing Acute Kidney Injury (AKI), which is linked to high mortality rates ranging from 10% to 80%. Timely recognition of at-risk patients and careful monitoring can significantly reduce the likelihood of kidney damage.Diagnostic Assessments:The diagnostic process starts with a comprehensive medical history to identify prerenal, intrarenal, and postrenal causes.Prerenal causes, such as dehydration, hypotension, or blood loss, should...
37
01:22Acute Kidney Injury I: Introduction
35
Introduction:Acute Kidney Injury (AKI) describes a swift decrease in kidney function occurring over hours to days, characterized by the kidneys' failure to remove waste products from the bloodstream. This leads to dangerous complications like metabolic acidosis, fluid overload, and electrolyte imbalances, such as hyperkalemia, which can cause life-threatening arrhythmias. AKI is common in both hospital and outpatient settings, often triggered by dehydration, sepsis, or exposure to nephrotoxic...
35
01:16Kidney Transplant III: Nursing Management
41
Postoperative Nursing Management for Kidney Transplant PatientsPostoperative nursing management care includes monitoring the surgical site, encouraging early movement, and promoting lung health through breathing exercises. Nurses also administer prescribed medications like H2-blockers, such as famotidine, or proton pump inhibitors, like omeprazole, to help prevent gastrointestinal ulcers and bleeding. Fungal infections in the mouth and bladder can result from immunosuppressive and antibiotic...
41
01:29Acute Kidney Injury III: Clinical Manifestations
40
Acute Kidney Injury (AKI) progresses through distinct clinical phases: the oliguric, diuretic, and recovery phases, each marked by unique manifestations and challenges.Oliguric Phase:The oliguric phase is the initial stage of AKI, typically lasting 10 to 14 days. This phase is marked by a significant reduction in urine output, usually less than 400 mL per day, indicating decreased kidney function. Fluid retention is a prominent feature, leading to symptoms such as edema, hypertension, and...
40
01:26Nursing Assessment of the Genitourinary System II: Inspection and Palpation
140
The nursing assessment of the genitourinary (GU) system involves a systematic inspection and palpation to identify abnormalities in the kidneys, bladder, and surrounding structures.InspectionMouth: Inspect for signs of kidney dysfunction, such as stomatitis (inflammation of the mouth) and ammonia breath, which may occur in advanced kidney disease due to the buildup of urea, breaking down into ammonia.Skin: Check for pallor, which could indicate anemia caused by kidney disease. Look for...
140
01:26Kidney Transplant II: Surgical Procedure
36
Preoperative ManagementThe primary goals of preoperative management in kidney transplantation are to optimize the patient’s metabolic state and prepare them for surgery through diet adjustments, necessary dialysis, and tailored medical treatment. This phase also involves comprehensive infection screening and patient education about the surgical procedure and postoperative care to improve outcomes and adherence.Medical ManagementA comprehensive evaluation is required for both the living...
36