Department of Anesthesiology and Critical Care, General Intensive Care Unit, Soroka Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel.
Trauma unit, Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel.
World J Emerg Surg. 2017 Aug 18;12:41. doi: 10.1186/s13017-017-0152-3. eCollection 2017.
The urine output is an important clinical parameter of renal function and blood volume status, especially in critically ill multiple trauma patients. In the present study, the minute-to-minute urine flow rate and its variability were analyzed in hypotensive multiple trauma patients during the first 6 h of their ICU (intensive care unit) stay. These parameters have not been previously reported.
The study was retrospective and observational. Demographic and clinical data were extracted from the computerized Register Information Systems. A total of 59 patients were included in the study. The patients were divided into two study groups. Group 1 consisted of 29 multiple trauma patients whose systolic blood pressure was greater than 90 mmHg on admission to the ICU and who were consequently deemed to be hemodynamically compromised. Group 2 consisted of 30 patients whose systolic blood pressure was less than 90 mmHg on admission to the ICU and who were therefore regarded as hemodynamically uncompromised.
The urine output and urine flow rate variability during the first 6 h of the patients' ICU stay was significantly lower in group 2 than in group 1 ( < 0.001 and 0.006 respectively). Statistical analysis by the Pearson method demonstrated a strong direct correlation between decreased urine flow rate variability and decreased urine output per hour ( = 0.17; = 0.009), decreased mean arterial blood pressure ( = 0.24; = 0.001), and increased heart rate ( = 0.205; = 0.001).
These findings suggest that minute-to-minute urine flow rate variability is a reliable incipient marker of hypovolemia and that it should therefore take its place among the parameters used to monitor the hemodynamic status of critically ill multiple trauma patients.
尿量是肾功能和血容量状态的一个重要临床参数，尤其是在危重症多发创伤患者中。在本研究中，分析了低血压多发创伤患者在 ICU 入住的最初 6 小时内的每分种尿流率及其变异性。这些参数以前尚未报道过。
本研究为回顾性和观察性研究。从计算机化的登记信息系统中提取了人口统计学和临床数据。共有 59 名患者纳入本研究。患者被分为两个研究组。第 1 组由 29 名多发创伤患者组成，这些患者在进入 ICU 时的收缩压大于 90mmHg，因此被认为存在血流动力学受损。第 2 组由 30 名收缩压小于 90mmHg 的患者组成，因此被认为血流动力学未受损。
在 ICU 入住的最初 6 小时内，第 2 组患者的尿量和尿流率变异性明显低于第 1 组（分别为<0.001 和 0.006）。通过 Pearson 方法进行的统计分析表明，尿流率变异性降低与每小时尿量减少（r=0.17；p=0.009）、平均动脉血压降低（r=0.24；p=0.001）和心率增加（r=0.205；p=0.001）之间存在强烈的直接相关性。
这些发现表明，每分种尿流率变异性是低血容量的可靠早期标志物，因此它应该在用于监测危重症多发创伤患者血流动力学状态的参数中占有一席之地。
