静脉输入体积扩张以防止与对比相关的急性损伤
Carlo Briguori1, Antonietta Di Iorio1, Guido Riviezzo1
1Interventional Cardiology Unit, Mediterranea Cardiocentro, Naples.
The Journal of invasive cardiology
|November 22, 2023
概括
静脉输入体积扩张可以预防慢性病 (CKD) 患者的对比相关急性损伤 (CA-AKI). 至少1430毫升的绝对体积膨胀是预防CA-AKI的理想选择.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 心脏病学 心脏病学
- 放射学 放射学是指放射学
背景情况:
- 与对比相关的急性损伤 (CA-AKI) 是慢性病 (CKD) 患者的重大风险.
- 静脉注射体积扩大是一种常见的策略,以减轻CA-AKI风险.
- 对于接受侵袭性心血管手术的CKD患者,最佳体积扩张方案仍在争论中.
研究的目的:
- 确定理想的静脉注射体积扩张策略,以预防慢性病患者的CA-AKI.
- 在这个高风险人群中比较不同体积扩张协议的疗效.
主要方法:
- 从6项研究 (2000-2019) 中对1927名CKD患者的综合分析.
- 四种体积膨胀方案的比较:常规,二碳酸盐,左心室末端透气压导向和尿液流速导向.
- 分析CA-AKI发生率,体积扩张金额和相关结果.
主要成果:
- CA-AKI发生在11%的患者中,与较低的体积膨胀和较高的肺水率有关.
- 接收器操作特征 (ROC) 曲线分析确定了CA-AKI预防的最佳值.
- 绝对体积膨胀≥1430毫升 (AUC=0.70) 和体积膨胀与对比率≥17 (AUC=0.57) 是避免CA-AKI的最佳预测因素.
结论:
- 绝对体积膨胀≥1430毫升和体积膨胀与对比率≥17是预防慢性病患者CA-AKI的有效值.
- 这些发现为临床实践提供了务实的,基于证据的切断线.
- 建议进行进一步的专门试验以验证这些值.
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