Swärd Kristina, Valsson Felix, Sellgren Johan, Ricksten Sven-Erik
Department of Cardiothoracic Anaesthesia and Intensive Care, Sahlgrenska University Hospital Göteborg, 41345 Göteborg, Sweden.
Intensive Care Med. 2004 Sep;30(9):1776-82. doi: 10.1007/s00134-004-2380-8. Epub 2004 Jul 28.
To evaluate various treatment strategies in critically ill patients with ischaemic acute renal failure, there is a need for reliable bedside measurements of total renal blood flow (RBF), glomerular filtration rate (GFR) and renal oxygen consumption without the need for urine collection.
The continuous renal vein thermodilution method and the infusion clearance techniques were validated against the gold standard technique, the urinary clearance of paraaminohippurate (PAH) and chromium ethylenediaminetetraacetic acid, respectively.
University hospital cardiothoracic ICU.
Seventeen uncomplicated mechanically ventilated post-cardiac surgical patients.
None.
Renal blood flow, GFR and the renal filtration fraction (FF) were measured for two consecutive 30-min periods by urinary clearance and compared with simultaneous measurements made by the thermodilution and infusion clearance techniques. Urinary clearance for PAH was corrected for by renal extraction of PAH. The within-group error, repeatability coefficient and the coefficient of variation were highest for the thermodilution technique and lowest for the infusion clearance technique with regard to RBF, GFR and FF. The infusion clearance technique had a higher agreement with the urinary clearance method than the thermodilution method. For estimations of RBF and GFR, the between-group errors were 33% and 43% comparing infusion clearance with urinary clearance and 65% and 67% comparing thermodilution with urinary clearance.
The infusion clearance method had the highest reproducibility and the highest agreement with the urinary clearance reference method. The renal vein thermodilution technique is less reliable in the ICU setting due to poor repeatability and poor agreement with the reference method.
为评估缺血性急性肾衰竭重症患者的各种治疗策略，需要在无需收集尿液的情况下，于床旁可靠地测量肾血流量（RBF）、肾小球滤过率（GFR）和肾氧耗量。
连续肾静脉热稀释法和输注清除技术分别与金标准技术（对氨基马尿酸（PAH）和铬乙二胺四乙酸的尿清除率）进行了验证。
大学医院心胸外科重症监护病房。
17例心脏手术后未出现并发症的机械通气患者。
无。
通过尿清除率连续两个30分钟时间段测量肾血流量、GFR和肾滤过分数（FF），并与热稀释法和输注清除技术同时进行的测量结果相比较。PAH的尿清除率通过PAH的肾摄取进行校正。就RBF、GFR和FF而言，热稀释技术的组内误差、重复性系数和变异系数最高，输注清除技术最低。输注清除技术与尿清除率方法的一致性高于热稀释法。对于RBF和GFR的估计，输注清除率与尿清除率比较时组间误差分别为33%和43%，热稀释法与尿清除率比较时组间误差分别为65%和67%。
输注清除法具有最高的可重复性，且与尿清除率参考方法的一致性最高。在重症监护病房环境中，肾静脉热稀释技术因重复性差且与参考方法一致性差而可靠性较低。
