尿源性脓毒症休克血流动力学特点和预后的临床分析

目的：了解尿源性脓毒症休克的血流动力学特点及预后。方法选取尿源性脓毒症休克患者30例，同期其他脓毒症休克患者30例作为对照组。比较两组患者早期液体复苏治疗后6h和12h的血流动力学参数，24h复苏所需液体正平衡量，病程需去甲肾上腺素总量，心脏和肾脏损伤情况及28d病死率。结果与对照组比较，研究组的6、12h的CVP、MAP、ScvO2明显升高、SVV明显下降（P＜0.05）。研究组第1个24h复苏液体正平衡总量较对照组少，心肌损伤发生率和急性肾功能损伤发生率较对照组明显增加（P＜0.05），需要去甲肾上腺素维持的总量较对照组多，28d病死率较对照组明显升高（P＜0.05）。结论尿源性脓毒症休克患者早期具有心肌损伤，急性肾功能损伤发生率高，对容量复苏接受能力差，易发生心功能衰竭的特点。液体复苏需在严密血流动力学监测下进行。

Hemodynamic characteristics and prognosis of patients with uroseptic shock

Objective To assess the hemodynamic characteristics and prognosis of patients with uroseptic shock. Methods Thirty patients with uroseptic shock and 30 patients with septic shock of other sources were included in the study. The hemodynamic parameters at 6h and 12h of early goal- directed therapy, the amount of fluid balance, the incidence of myocardial and kidney injury in the first 24h, the total dose of norepinephrine and 28- day mortality were compared between two groups. Results At 6h and 12h of early goal- directed therapy, patients of uroseptic shock had higher CVP, MAP,ScvO2,lower SVV;less amount of fluid in the first 24h,more dose of norepinephrine, more incidence of myocardial and acute kidney injury, higher 28- day mortality than other septic shock group. Conclusion Patients of uroseptic shock are more prone to heart failure and acute renal injury in early stage than other septic shock patients. It is necessary to closely monitor the hemodynamic parameters for fluid re-suscitation in patients with uroseptic shock.