感染性休克致急性肾损伤的血流动力学研究

目的研究感染性休克导致的急性肾损伤血流动力学的改变,以期为临床诊治提供一定的参考。方法选取2011年1月~2013年1月入院诊治的感染性休克合并急性肾损伤的患者40例,回顾性分析其临床资料,统计其血流动力学改变。结果高、低CVP组患者在0 h、24 h的HR、MAP、CI、EVLWI、Lac、ScvO2、APACHEⅡ评分均无显著差异。但0 h、24 h低CVP组的SVRI与GEDVI均高于高CVP组。两组差异显著(P<0.05)。28 d后生存20例,死亡20例,其中0 h时生存组CVP低于死亡组;24 h时生存组CI、MAP显著高于死亡组,而SVRI显著低于死亡组。上述数据具有统计学意义(P<0.05)。结论 CVP升高提示感染性休克导致急性肾损伤;血流动力学的改变会影响患者的预后,可为临床判定预后提供一定的参考作用。

Study on hemodynamics of infectious shock causing acute kidney injury

Objective To study the hemodynamics of acute kidney injury caused by infectious shock, for providing reference for clinical diagnosis and treatment. Methods All 40 patients with infectious shock and acute kidney injury treated in our hospital from January 2011 to January 2013 were selected. The clinical data of patients were analyzed retrospectively. And the hemodynamics was observed. Results For the high and low CVP group, MAP, CI, EVLWI, Lac, ScvO2 and APACHE II score in 0 h and 24 h had no evident difference. But SVRI and GEDVI of 0 h and 24h of low CVP group were higher than that of the high CVP group. The difference between two groups was significant （P〈0.05）. After 28 days, there were 20 survival cases, and 20 dead cases, in which the CVP of 0 h in the survival group was lower than that of the dead group. CI and MAP of 24 h in the survival group were evidently higher than that of the death group, and SVRI was evidently lower than that of the death group. The above data had statistical significance （P〈0.05）. Conclusion Increase of CVP indicates infectious shock causing acute kidney injury. The change of hemodynamics can influence the prognosis of patients, which provides reference for clinical prognosis.