早期持续暴露于高CVP与性休克增加的死亡率和AKI有关:一项回顾性研究
Wenyan Xiao1, Wanjun Liu1, Jin Zhang1
1The Second Department of Critical Care Medicine, the Second Affiliated Hospital of Anhui Medical University, Anhui, Hefei 230601, PR China; The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, the Second Affiliated Hospital of Anhui Medical University, Anhui, Hefei 230601, PR China.
The American journal of emergency medicine
|October 14, 2023
概括
在接受ICU治疗的24小时内,在败血症休克患者中保持6-12cmH2O之间的中央静脉压力 (CVP) 是至关重要的. 长期高CVP暴露显著增加28天死亡率和急性损伤风险.
科学领域:
- 临界护理医学 临界护理医学
- 腎臟病學 (nephrology) 是一種醫學專業.
- 血液动力学 血液动力学
背景情况:
- 败血冲击管理涉及血液动力学监测,包括中央静脉压力 (CVP).
- CVP变异性与患者的死亡率和急性损伤 (AKI) 等结果之间的关系需要进一步阐明.
- 优化CVP是提高生存率和减少危急病患者器官损伤的必要条件.
研究的目的:
- 为了研究中枢静脉压 (CVP) 暴露随时间推移和败血性休克患者28天死亡率之间的关联.
- 确定不同CVP强度和持续时间对急性损伤 (AKI) 发生率的影响.
- 在初始重症监护室 (ICU) 入院阶段,为患有败血性休克的患者确定最佳的CVP范围.
主要方法:
- 利用了来自阿姆斯特丹UMCdb的数据,包括需要CVP监测的成年感染性休克患者.
- 采用零碎指数增益混合模型来分析CVP与结果之间的时间变化的关联.
- 评估了28天死亡率和AKI发病率,分别是主要和次要结局.
主要成果:
- 总共有9668名患者被分析,28天死亡率为8.2%,AKI发病率为41.1%.
- 时间加权平均CVP与28天死亡率的增加密切相关,特别是在ICU入院后的前24小时内.
- 在最初的24小时内超过5小时暴露于高CVP (>12cmH2O) 时,死亡风险增加了2.69倍,并显著增加了AKI风险.
结论:
- 在ICU入院后24小时内,败血性休克患者的最佳CVP范围为6-12cmH2O.
- 长时间暴露于高CVP (>12cmH2O) 超过5小时,会显著增加死亡风险.
- 保持CVP在推范围内对于降低死亡率和预防性休克中AKI至关重要.
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