连续性肾脏替代治疗开始时的超声心动图参数与血流动力学不稳定
Echocardiographic parameters and hemodynamic instability at the initiation of continuous kidney replacement therapy.
作者信息
Kompotiatis Panagiotis, Shawwa Khaled, Jentzer Jacob C, Wiley Brandon M, Kashani Kianoush B
机构信息
Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA.
出版信息
J Nephrol. 2023 Jan;36(1):173-181. doi: 10.1007/s40620-022-01400-2. Epub 2022 Jul 18.
OBJECTIVE
Investigate the association of echocardiographic parameters with hemodynamic instability after initiating continuous kidney replacement therapy (CKRT) in a cohort of intensive care unit (ICU) patients requiring CKRT.
METHODS
Historical cohort study of consecutive adults admitted to the ICU at a tertiary care hospital from December 2006 through November 2015 who underwent CKRT and had an echocardiogram done within seven days before CKRT initiation. The primary outcome was hypotension within one hour of CKRT initiation.
RESULTS
We included 980 patients, 804 (82%) with acute kidney injury (AKI) and 176 (18%) with end-stage kidney disease (ESKD). Median patient age was 63 (± 14) years, and median Sequential Organ Failure Assessment (SOFA) score on the day of CKRT initiation was 12 (IQR 10-14). Multivariable analysis showed that Left (OR 2.01, 95% CI 1.04-3.86), and Right (OR 1.5, 95% CI 1.04-2.25) moderate and severe ventricular enlargement, Vasoactive-Inotropic Score (VIS) one hour before CKRT initiation (OR 1.18 per 10 units increase, 95% CI 1.09-1.28) and high bicarbonate fluid replacement (OR 2.52, 95% CI 1.01-6.2) were associated with hypotension after CKRT initiation.
CONCLUSION
Right and left ventricular enlargement are risk factors associated with hypotension after CKRT initiation.
目的
在一组需要持续肾脏替代治疗（CKRT）的重症监护病房（ICU）患者中，研究超声心动图参数与开始CKRT后血流动力学不稳定之间的关联。
方法
对2006年12月至2015年11月在一家三级护理医院ICU连续收治的成年患者进行回顾性队列研究，这些患者接受了CKRT，并在开始CKRT前7天内进行了超声心动图检查。主要结局是CKRT开始后1小时内出现低血压。
结果
我们纳入了980例患者，其中804例（82%）为急性肾损伤（AKI），176例（18%）为终末期肾病（ESKD）。患者中位年龄为63（±14）岁，CKRT开始当天序贯器官衰竭评估（SOFA）评分中位数为12（四分位间距10 - 14）。多变量分析显示，左心室（比值比[OR] 2.01，95%置信区间[CI] 1.04 - 3.86）和右心室（OR 1.5，95% CI 1.04 - 2.25）中重度扩大、CKRT开始前1小时血管活性-正性肌力评分（VIS）（每增加10个单位OR 1.18，95% CI 1.09 - 1.28）以及高碳酸氢盐液体置换（OR 2.52，95% CI 1.01 - 6.2）与CKRT开始后低血压相关。
结论
左右心室扩大是CKRT开始后与低血压相关的危险因素。
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