危重患者的速尿应激试验、电解质反应肾脏指数
危重患者的速尿应激试验、电解质反应肾脏指数
贵州医科大学 麻醉与心脏电生理课题组
翻译：陈锐 编辑：陈锐 审校：曹莹
急性肾损伤(AKI)是危重患者常见的并发症。传统标志物如血清肌酐的诊断能力最近已经受到质疑，使用新的测试如呋塞米压力试验或肾阻力指数的超声评估已经被提出。本研究的目的是比较机械通气患者入院时对呋塞米应激试验的反应，急性肾损伤患者和非急性肾损伤患者的肾脏指数，以及在入院第三天时有无发生急性肾损伤患者在CIU 入院时肾功能正常者的肾脏指数。
在一般重症监护病房连续收治的机械通气患者中使用前瞻性观察性研究。在入院时进行速尿应激试验和超声肾脏指数检查，并在速尿应激试验前后两小时收集临床和实验室资料。记录第一、二小时的尿量。
研究纳入了四十例患者，其中19例入院时患有AKI。急性肾损伤患者肾脏指数明显升高(0.77 ± 0.07 vs 0.72 ± 0.08，p = 0.027) ，速尿应激试验后肾脏指数明显降低(400[340; 1400] vs 1525[400; 2550] mL; p = 0.013)。有和无 AKI 患者在呋塞米应激试验前后血浆钠、钾、氯浓度无明显差异，而 AKI 患者尿钠、钾、氯总量明显低于无 AKI 患者。相似的结果出现在入院时没有发生 AKI 和在第三天发生AKI的患者与那些没有发生AKI的患者。
速尿应激试验的反应和肾脏指数可作为评价危重患者肾功能的补充指标。
Bolgiaghi L, Umbrello M, Formenti P, et al. The furosemide stress test, electrolyte response and Renal Index in critically ill patients. Minerva Anestesiol 2021;87:448-57. DOI: 10.23736/S0375-9393.21.14942-9。
The furosemide stress test, electrolyte response and Renal Index in critically ill patients
ABSTRACT
BACKGROUND: Acute kidney injury (AKI) is a common syndrome in critically ill patients. The diagnostic ability of traditional markers such as serum creatinine has recently been questioned, and the use of newer tests such as the furosemide stress test or the ultrasound assessment of renal resistive index have been proposed. Aim of the present study was to compare the response to a furosemide stress test, the Renal Index in mechanically ventilated patients with and without acute kidney injury at admission, and who did or did not develop AKI at day three, among those with normal renal function at the CIU admission.
METHODS: Prospective observational study in consecutive mechanically ventilated patients admitted in a general intensive care. Furosemide stress test and ultrasonographical Renal Index were performed at the admission and clinical and laboratory data were collected before and two hours after the furosemide stress text. The urine output after the first and the second hours was recorded.
RESULTS: Forty patients were enrolled, 19 of whom had AKI at admission. The Renal Index was significantly higher in patients with AKI (0.77±0.07 vs. 0.72±0.08, P=0.027); patients with AKI had a significantly lower urine output after the furosemide stress test (400 [340; 1400] vs.1525 [400; 2550] mL; P=0.013). The plasma concentrations of sodium, potassium and chloride were not different before and after the furosemide stress test in patients with and without AKI, whereas in patients with AKI, the total urine output of sodium, potassium and chloride were significantly lower compared to patients without AKI. Similar results were found in patients without AKI at admission and who developed AKI at day three as compared to those who did not develop AKI.
CONCLUSIONS: The response to the furosemide stress test and the Renal Index could be used as additional tools to evaluate the kidney function in critically ill patients.
(Cite this article as: Bolgiaghi L, Umbrello M, Formenti P, Coppola S, Sabbatini G, Massaro C, et al. The furosemide stress test, electrolyte response and Renal Index in critically ill patients. Minerva Anestesiol 2021;87:448-57. DOI: 10.23736/S0375-9393.21.14942-9)
KEY WORDS: Acute kidney injury; Observational study; Renal replacement therapy.