使用高级血液动力学监测在接受连续脏置换治疗的重症患者中尿液输出的决定因素
Laurent Bitker1,2,3, Charlotte Biscarrat1, Hodane Yonis1
1Service de Médecine Intensive - Réanimation, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France.
Blood purification
|December 17, 2023
概括
接受连续脏替代疗法 (CRRT) 的重症监护病房患者通常会迅速失去尿量 (UO). 血液动力学因素,包括中风体积指数和预负荷依赖,是CRRT期间UO的关键决定因素.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 临界护理医学 临界护理医学
- 心脏病学 心脏病学
背景情况:
- 低心力输出和低血压是接受CRRT的ICU患者新发性无尿症的潜在原因.
- 了解宏循环机制对于在CRRT期间管理尿液输出至关重要.
研究的目的:
- 为了确定血液动力学参数和CRRT设置,影响ICU患者的UO纵向过程.
- 调查连续脏替代疗法期间血液动力状态和尿液输出之间的关系.
主要方法:
- 对PRELOAD CRRT观察性研究的辅助分析.
- 监测血液动力学 (SVI,预负载依赖性),净超过 (UFNET) 和UO在CRRT严重急性损伤的成年患者.
- 根据UO.在纳入时将患者分为非无尿和无尿组.
主要成果:
- 大多数非无尿症患者 (78%) 在CRRT开始后19小时内进展为无尿症.
- 冲击体积指数 (SVI) 和预负荷依赖与研究组和时间有显著的关联.
- 较低的UO与较低的SVI,较低的平均动脉压 (MAP) 和预负载独立性相关;较高的UFNET与较低的UO有关.
结论:
- 在CRRT的ICU患者经历治疗开始后尿液的快速下降,即使最初没有尿液.
- perfusion 和有效的 volemia 的血液动力学指标是 CRRT 期间 UO 的主要驱动因素.
- UFNET设置的血液动力学影响显著影响UO.
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