在自由与限制性流体治疗下,以生物标志物为指导的急性损伤风险评估 - - 前性随机化MAYDAY试验
Alexandra M Anker1, Marc Ruewe2, Lukas Prantl2
1Department of Plastic, Reconstructive, Aesthetic, and Hand Surgery, University Hospital Regensburg, University of Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany. alexandra.anker@ukr.de.
Scientific reports
|July 24, 2024
概括
限制性液体复苏增加了手术患者急性损伤 (AKI) 的风险. 像TIMP-2和IGFBP-7这样的新型尿路生物标志物有助于早期发现AKI,指导个性化流体管理.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學.
- 手术瘤学手术瘤学
- 临界护理医学 临界护理医学
背景情况:
- 急性损伤 (AKI) 是手术患者的一个重大问题,目前的监测方法,如血清肌素和尿液输出有局限性.
- 手术期间的脏保护策略,特别是手术期间的流体管理,需要进一步研究.
研究的目的:
- 评估自由 (LFA) 与限制性 (FRV) 流体管理对接受自主乳腺重建的女性乳腺癌患者AKI发病率的影响.
- 评估新型尿路生物标志物 (TIMP-2和IGFBP-7) 在检测应激早期迹象方面的有用性.
主要方法:
- 一个单一的前性随机受控试验,涉及40名患者,比较LFA和FRV策略.
- 使用NephroCheck测量尿中的TIMP-2和IGFBP-7水平,在手术前,手术后和24小时手术后的时间点.
- 根据KDIGO标准进行AKI诊断.
主要成果:
- 限制性流体体积复苏 (FRV) 组显示显着更高的直接术后TIMP-2和IGFBP-7水平,表明管应激.
- 虽然不具有统计学意义 (p=0.385),但AKI的发病率在FRV组 (21%) 与LFA组 (13%) 相比较高.
- 尿路生物标志物显示出早期检测损伤的潜力.
结论:
- 限制性手术内液体复苏可能会增加手术患者AKI的风险.
- 个性化血液动力学管理对于预防AKI至关重要.
- 尿路生物标志物TIMP-2和IGFBP-7是早期AKI检测和在外科期间监测功能的宝贵工具.
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