速尿对感染性休克患者尿液氧合作用的影响。

Effect of Furosemide on Urinary Oxygenation in Patients with Septic Shock.

机构信息

Department of Intensive Care, Austin Hospital, Heidelberg, Victoria, Australia,

Department of Intensive Care, Austin Hospital, Heidelberg, Victoria, Australia.

出版信息

Blood Purif. 2019;48(4):336-345. doi: 10.1159/000501512. Epub 2019 Jul 23.

DOI:10.1159/000501512

PMID:31336370

Abstract

BACKGROUND

Renal medullary hypoxia precedes the development of acute kidney injury in experimental sepsis and can now be assessed by continuous measurement of urinary oxygen tension (PuO2).

OBJECTIVES

We aimed to test if PuO2 measurements in patients with septic shock would be similar to those shown in experimental sepsis and would detect changes induced by the administration of furosemide.

METHOD

Pilot prospective observational cohort study in a tertiary intensive care unit (ICU). Seven adult patients with septic shock admitted to ICU had PuO2 measurements recorded minutely. There were 29 episodes of intravenous furosemide (20 mg n = 19; 40 mg n = 10).

RESULTS

The median pre-furosemide PuO2 was low at 21.2 mm Hg (interquartile range [IQR] 17.73-24.86) and increased to 26 mm Hg (IQR 20.27-29.95) at 20 min (p < 0.01), to 27.5 mm Hg (IQR 24.06-33.18) at 40 min (p < 0.01) and to 28.5 mm Hg (IQR 22.65-31.03) at 60 min (p < 0.01). The increase in PuO2 was greater in episodes with a diuretic response >2 mL/kg/h than during episodes without such a response (p < 0.01).

CONCLUSIONS

PuO2 measurements in patients are reflective of the low values reported in experimental models of sepsis. PuO2 values increased following furosemide administration with a response independently associated with greater diuresis.

摘要

背景

在实验性脓毒症中，肾髓质缺氧先于急性肾损伤的发生，现在可以通过连续测量尿氧分压（PuO2）来评估。

目的

我们旨在测试脓毒性休克患者的 PuO2 测量值是否与实验性脓毒症中所显示的相似，并检测呋塞米给药引起的变化。

方法

在一家三级重症监护病房（ICU）进行的前瞻性观察性队列研究。7 名脓毒性休克成年患者接受 ICU 内 PuO2 分钟测量记录。共进行了 29 次静脉注射呋塞米（20 mg n = 19；40 mg n = 10）。

结果

在使用呋塞米之前，PuO2 的中位数较低，为 21.2 毫米汞柱（IQR 17.73-24.86），在 20 分钟时增加到 26 毫米汞柱（IQR 20.27-29.95）（p < 0.01），在 40 分钟时增加到 27.5 毫米汞柱（IQR 24.06-33.18）（p < 0.01），在 60 分钟时增加到 28.5 毫米汞柱（IQR 22.65-31.03）（p < 0.01）。在利尿反应 >2 mL/kg/h 的发作中，PuO2 增加量大于无此类反应的发作（p < 0.01）。