摘要
目的 探讨肾阻力指数(renal resistance index,RRI)和肾灌注压(RPP)估算值多模化监测在预测急性重度有机磷中毒(acute severe organophosphate poisoning,ASOPP)患者发生急性肾损伤(AKI)的意义。方法 选择2020年1月至2021年12月单县中心医院重症医学科(ICU)收治的ASOPP患者为研究而对象。记录患者一般临床资料,包括性别、年龄、体重指数、血清胆碱酯酶(CHE)、血清白蛋白(Alb)、血清肌酐(Cr)、动脉血乳酸(ALac)、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)、上肢平均动脉血压(MAP)、中心静脉压(CVP)和腹内压(IAP),计算肾灌注压估算值(eRPP)。彩色超声测量并获得RRI。根据患者入院48 h内是否发生AKI分为AKI组与非AKI组。采用多因素Logistic回归分析发生AKI的危险因素,用受试者工作特征(ROC)曲线分析相应指标的预测价值。结果 共入选98例患者,其中AKI组42例,非AKI组56例。AKI组CHE(kU/L:1.9±0.6 vs.2.2±0.5,P=0.023)、24 h eRPP(mm Hg:54.6±6.2 vs.59.6±5.5,P=0.000)低于非AKI组,ALac(mmol/L:2.8±0.9 vs.2.4±0.6,P=0.019)、APACHEⅡ评分(分:24.1±3.2 vs.22.7±2.8,P=0.023)、24 h CVP(mm Hg:10.9±2.9 vs.9.0±2.3,P=0.001)、24 h RRI(0.70±0.04 vs.0.67±0.04,P=0.001]高于非AKI组。Logistic回归分析显示,入院24 h RRI、24 h eRPP为ASOPP患者发生AKI的独立危险因素,联合应用24 h RRI和24 h eRPP预测ASOPP患者发生AKI的敏感度为59.5%,特异度为89.3%,ROC曲线下面积(AUC)为0.784,约登指数为0.488。结论 24 h RRI和24 h eRPP是ASOPP患者发生AKI的危险因素,24 h RRI联合24 h eRPP多模化监测有利于预测AKI的发生。
Objective To investigate the significance of multimodal monitoring of renal resistance index(RRI) and renal perfusion pressure(RPP) in predicting acute kidney injury(AKI) in the patients with acute severe organophosphorus pesticide poisoning(ASOPP).Methods The patients with ASOPP admitted to the Intensive Care Unit of Shanxian Central Hospital from January 2020 to December 2021 were selected as the study subjects.The general clinical data of patients were recorded,gender,age,body mass index,serum cholinesterase(CHE),serum albumin,serum creatinine(Cr),arterial blood lactate(ALac),APACHEⅡ score,upper limb mean arterial blood pressure(MAP),central venous pressure(CVP),intra-abdominal pressure(IAP),and estimated renal perfusion pressure(eRPP) were calculated.Renal RRI was measured by color doppler ultrasound.Patients were divided into AKI group and non-AKI group according to whether AKI occurred within 48 h after admission.Multivariate Logistic regression was used to analyze the risk factors of AKI,and receiver operating characteristic(ROC) curve was used to analyze the predictive value of corresponding indicators.Results A total of 98 patients were selected,including 42 in AKI group and 56 in non-AKI group.CHE [kU/L:1.9±0.6 vs.2.2±0.5,P=0.023] and 24 h eRPP [mm Hg:54.6±6.2 vs.59.6±5.5,P=0.000] in AKI group were lower than those in non-AKI group.ALac [mmol/L:2.8±0.9 vs.2.4±0.6,P=0.019),APACHE Ⅱ score [scores:24.1±3.2 vs.22.7±2.8,P=0.023),24 h CVP [mm Hg:10.9±2.9 vs.9.0±2.3,P=0.001),24 h RRI(0.70±0.04 vs.0.67±0.04,P=0.001) were higher in AKI group than in non-AKI group.Logistic regression analysis showed that 24 h eRPP and 24 h RRI were independent risk factors for AKI in the ASOPP patients.The sensitivity and specificity of combined application of 24 h eRPP and 24 h RRI to predict AKI in the ASOPP patients were 59.5% and 89.3%,respectively.AUC_(ROC) was 0.784 and Yoden index was 0.488.Conclusions 24 h RRI and 24 h eRPP are risk factors for AKI in the ASOPP patients.24 h RRI combined with 24 h eRPP mul
作者
刘景刚
杨文宝
陈爽
张哲
张珂
Liu Jing-gang;Yang Wen-bao;Chen-shuang;Zhang-zhe;Zhang-ke(Department of Critical Care Medicine,Shanxian Central Hospital,Shanxian 274300,China)
出处
《中国急救医学》
CAS
CSCD
2022年第8期683-687,共5页
Chinese Journal of Critical Care Medicine
基金
济宁医学院教师科研扶持基金(JYFC2018FKJ062)。
