摘要
目的 探讨呋塞米负荷试验(FST)对急性肾损伤(AKI)患者启动肾脏替代治疗(RRT)的预测价值。方法 纳入2016-07~2017-07兰州大学第一医院重症医学科收治的138例AKI患者,在RRT之前行FST,即静脉给予1.0 mg/kg呋塞米后记录第2小时尿量(FST-UO2h),观察RRT后患者的肾功能变化(分为进展组和未进展组)和病死率。以FST-UO2h小于等于200 mL为FST阴性,利用ROC曲线评价FST-UO2h预测RRT后患者肾功能恶化的特异度和敏感度。结果 进展组和未进展组患者RRT前的年龄、APACHEⅡ评分、SOFA评分等比较差异无统计学意义,进展组患者KDIGO Ⅱ期比例高于未进展组,且其住院时间和28 d病死率也高于未进展组。FST-UO2h预测RRT后肾功能恶化的ROC曲线下面积(AUC)(0.76±0.07,P=0.01)明显高于血肌酐(sCr)和中性粒细胞明胶酶相关载脂蛋白(NGAL)的AUC (分别为0.55±0.08,P=0.48和0.63±0.07,P=0.08)。结论 若AKI患者FST为阴性,提示其肾功能可能恶化,应尽早启动RRT。
Objective To investigate the predictive value of furosemide stress test (FST) in starting renal replacement therapy (RRT) of patients with acute kidney injury (AKI). Methods One hundred and thirty - eight patients with AKI admitted to the Department of Critical Care Medicine of the First Hospital of Lanzhou University were included. FST, that was furosemide was intravenously given to the patients and then the urine output of the second hour ( FST - UO2h ) was recorded, were taken before RRT. The renal function changes and mortality of included patients were observed after RRT. All patients were divided into progressive group and non - progressive group. With FST - UO2h less than or equal to 200 mL as FST negative, the ROC curve was used to evaluate the specificity and sensitivity of FST - UO2h to predict the deterioration of renal function after RRT. Results There was no significant difference in the age, APACHE Ⅱ score, and SOFA score before RRT between the progressive group and the non - progressive group. The proportion of KDIGO Ⅱ patients in the progressive group were higher than those in the non - progressive group, and the length of stay and the mortality of 28 d were also higher than those in the non - progressive group. The area under the ROC curve (AUC) of FST - UO2h (0.76 ± 0.07, P = 0.01 ) in predicting the function deterioration after RRT was significantly higher than the AUC of sCr and NGAL (0.55 ± 0.08, P = 0.48 and 0.63 ± 0.07, P = 0.08 respectively). Condttsion If FST of patients with AKI is negative, suggesting that the renal function may be worsen, the RRT should be initiated as soon as possible.
作者
窦志敏
李红
朱磊
李斌
刘健
Dou Zhi-min;Li Hong;Zhu Lei;Li Bin;Liu Jian(Department of Critical Care Medicine,the First Hospital of Lanzhou University,Lanzhou 730000,Chin)
出处
《中国急救医学》
CAS
CSCD
北大核心
2018年第7期586-589,I0003,共5页
Chinese Journal of Critical Care Medicine
基金
甘肃省自然科学基金项目(1308RJZA240)
甘肃省中医药管理局科研课题(GZK-2015-39)