Nogi Kazutaka, Shiraishi Atsushi, Yamamoto Ryohei, Sasano Mikio, Matsumoto Takashi, Karumai Toshiyuki, Hayashi Yoshiro
Department of Intensive Care Medicine, Kameda Medical Center, Kamogawa, Chiba, Japan.
Department of Cardiovascular Medicine, Nara Medical University, Nara, Japan.
Crit Care Explor. 2019 Dec 10;1(12):e0065. doi: 10.1097/CCE.0000000000000065. eCollection 2019 Dec.
Septic shock is often complicated by severe metabolic acidosis, for which renal replacement therapy may be considered. However, little is known about the use of intermittent hemodialysis to manage this condition. The aim of this study was to compare physiologic and biochemical variables and vasopressor requirements before and after intermittent hemodialysis among patients who received intermittent hemodialysis to manage metabolic acidosis during resuscitation of septic shock.
This retrospective, cross-sectional study was conducted between April 2014 and September 2015.
The ICU of a non-university-affiliated teaching hospital.
Patients who were admitted to the ICU with septic shock and underwent intermittent hemodialysis to manage metabolic acidosis within 48 hours after the diagnosis of septic shock.
The main outcomes were mean arterial pressure, minute ventilator volume, norepinephrine requirement, bicarbonate and pH before and after intermittent hemodialysis. Of 1,190 patients screened, 34 were included, and 33 accomplished a planned session of intermittent hemodialysis. After intermittent hemodialysis, an increased mean arterial pressure (+9.0 mm Hg; 95% CI, 6-13; < 0.001), decreased minute ventilatory volume (-2.0 L/min; 95% CI, -3.3 to 0.8; = 0.002), decreased norepinephrine requirement (-0.07 µg/kg/min; 95% CI, -0.12 to -0.02; = 0.009), increased bicarbonate level (+7.2 mmol/L; 95% CI, 6.1-8.3; < 0.001), and increased pH (+0.17; 95% CI, 0.13-0.21; < 0.001) were observed in comparison to those before intermittent hemodialysis.
In conclusion, intermittent hemodialysis appeared to be feasible and to stabilize hemodynamic and respiratory conditions in patients with septic shock complicated by metabolic acidosis during resuscitation.
感染性休克常并发严重代谢性酸中毒，对此可考虑采用肾脏替代治疗。然而，关于使用间歇性血液透析来处理这种情况的了解甚少。本研究的目的是比较在感染性休克复苏期间接受间歇性血液透析以处理代谢性酸中毒的患者在间歇性血液透析前后的生理和生化变量以及血管升压药需求。
本回顾性横断面研究于2014年4月至2015年9月进行。
一家非大学附属医院的重症监护病房。
因感染性休克入住重症监护病房且在感染性休克诊断后48小时内接受间歇性血液透析以处理代谢性酸中毒的患者。
主要结局指标为间歇性血液透析前后的平均动脉压、分钟通气量、去甲肾上腺素需求量、碳酸氢盐和pH值。在筛查的1190例患者中，34例被纳入，33例完成了计划的间歇性血液透析疗程。与间歇性血液透析前相比，间歇性血液透析后观察到平均动脉压升高（+9.0 mmHg；95%可信区间，6 - 13；P < 0.001）、分钟通气量降低（-2.0 L/min；95%可信区间，-3.3至0.8；P = 0.002）、去甲肾上腺素需求量降低（-0.07 μg/kg/min；95%可信区间，-0.12至-0.02；P = 0.009）、碳酸氢盐水平升高（+7.2 mmol/L；95%可信区间，6.1 - 8.3；P < 0.001）以及pH值升高（+0.17；95%可信区间，0.13 - 0.21；P < 0.001）。
总之，间歇性血液透析似乎可行，且可使复苏期间并发代谢性酸中毒的感染性休克患者的血流动力学和呼吸状况稳定。
