在接受间歇性血液透析的重症患者中预测内透析性低血压:一项前性观察性研究
Rogério da Hora Passos1,2, Fernanda Oliveira Coelho3, Juliana Ribeiro Caldas4
1Departamento de Pacientes Graves, Hospital Israelita Albert Einstein, Av Albert Einstein, 627/701, Morumbi, São Paulo, SP, Brazil. oiregorpassos@yahoo.com.br.
Intensive care medicine experimental
|September 27, 2024
概括
被动腿抬起 (PLR) 测试可以预测急性损伤 (AKI) 患者在透析期间的低血压. 这种血液动力学评估,与动态弹性不同,有助于识别患有内部透析性低血压 (IDH) 风险的患者.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 关键护理医学 关键护理医学
- 血液动力学 血液动力学
背景情况:
- 在急性损伤 (AKI) 患者中,日内低血压 (IDH) 源于血管运动调节变化和低血压.
- 在AKI患者中,反调节机制经常被破坏,使置换疗法 (KRT) 期间的低血压管理复杂化.
研究的目的:
- 评估预负载依赖的预测值,通过被动腿部提升 (PLR) 测试评估,以及IDH的动脉度 (动态弹性,Eadyn).
- 在接受间歇性血液透析的重症AKI患者中确定IDH的关键预测因子.
主要方法:
- 一项在第三级医院ICU中的前性观察性研究,涉及接受间歇性血液透析的重症AKI患者.
- 使用FloTrac/Vigileo系统监测血液动力学参数,包括基线PLR测试和KRT之前的Eadyn计算.
- IDH被定义为平均动脉压 (MAP) <65 mmHg;逻辑回归和卡普兰-梅尔分析用于预测和生存评估.
主要成果:
- 在187名患者中,有27.3%的患者经历了IDH.
- 阳性PLR测试 (表明预加载依赖性) 与IDH (OR 8.54) 有意义地相关.
- 基线Eadyn没有预测效果;北上腺素使用和较低的基线MAP也是显著的IDH预测因子. IDH和阳性PLR与90天生存率降低相关.
结论:
- PLR测试是KRT接受的重症AKI患者IDH的一个有价值的预测指标.
- 基线动态弹性 (Eadyn) 在这个队列中没有显示IDH的预测值.
- 持续的血液动力学监测,包括预负载评估,可以改善患者管理和IDH预防的结果.
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