General Intensive Care Unit, Department of Anesthesiology and Critical Care, Soroka Medical Center, Ben-Gurion University of the Negev, Beersheba, Israel.
Division of Trauma, Sheba Medical Center, Ramat Gan, Israel.
Eur J Trauma Emerg Surg. 2020 Oct;46(5):1175-1181. doi: 10.1007/s00068-019-01090-9. Epub 2019 Feb 13.
Dynamic changes in urine output and neurological status are the recognized clinical signs of hemodynamically significant hemorrhage. In the present study, we analyzed the dynamic minute-to-minute changes in the UFR and also the changes in its minute-to-minute variability in a group of critically ill multiple trauma patients whose blood pressures were normal on admission to the ICU but who subsequently developed hypotension within the first few hours of their ICU admission.
The study was retrospective and observational. Demographic and clinical data were extracted from the computerized register information systems initially; the clinical and laboratory data of 100 critically ill patients with multiple trauma who were admitted to the ICU during the study period were analyzed. Of this group, ten patients were eventually included in the study on the basis of the inclusion criteria.
The minute-to-minute urine flow rate (UFR) and urine flow rate variability (UFRV) both decreased significantly during the periods of hypotension (p values 0.001 and 0.006, respectively). Notably, the decrease in UFRV preceded by at least 30 min a corresponding decline in the systolic and mean arterial blood pressures, which manifested as a flattening of UFRV amplitude which was observed prior to the occurrence of the lowest recorded systolic and mean arterial blood pressures. Statistical analysis by the Pearson method demonstrated a strong direct correlation between the decrease in UFRV and the decrease in the MAP (R = 0.9, p = 0.001), and SBP (R = 0.86, p = 0.001) and the decreasing urine output per hour (R = 0.88, p < 0.001).
We found that changes in UFRV correlate strongly with systolic and mean arterial blood pressures. We feel that this parameter could potentially serve as an early signal of hemodynamic deterioration due to occult bleeding in critically ill trauma patients, and might also be able to identify the optimal end-point of hemodynamic resuscitative measures in these patients.
尿流量和神经状态的动态变化是血液动力学显著出血的公认临床标志。在本研究中，我们分析了一组危重症多发创伤患者的 UFR 分钟到分钟的动态变化，这些患者在进入 ICU 时血压正常，但在进入 ICU 的最初几个小时内出现低血压。
本研究为回顾性和观察性研究。最初从计算机登记信息系统中提取人口统计学和临床数据；对研究期间入住 ICU 的 100 例危重症多发创伤患者的临床和实验室数据进行了分析。在此组中，根据纳入标准，最终有 10 例患者纳入研究。
在低血压期间，分钟尿流量（UFR）和尿流量变异性（UFRV）均显著下降（p 值分别为 0.001 和 0.006）。值得注意的是，UFRV 的下降至少提前 30 分钟伴随着收缩压和平均动脉血压的相应下降，表现为 UFRV 幅度的变平，这发生在记录到的最低收缩压和平均动脉血压之前。通过 Pearson 方法进行的统计学分析显示，UFRV 的下降与 MAP（R = 0.9，p = 0.001）和 SBP（R = 0.86，p = 0.001）的下降以及每小时尿量的减少之间存在很强的直接相关性（R = 0.88，p < 0.001）。
我们发现 UFRV 的变化与收缩压和平均动脉血压密切相关。我们认为，这个参数可能是危重症创伤患者隐匿性出血导致血液动力学恶化的早期信号，并可能能够确定这些患者血液动力学复苏措施的最佳终点。
