呋塞米激发试验对感染性休克早期急性肾损伤患者预后的预测价值

摘要

目的 探讨呋塞米激发试验(FST)对感染性休克早期急性肾损伤(AKI)患者预后的预测价值.方法 前瞻性选取2014-02～2016-12无锡市人民医院ICU及EICU收治的72例感染性休克早期AKI(AKI 1级和AKI 2级)患者,经充分液体复苏后分别给予单次静脉注射标准剂量呋塞米(试验前7d内未接受过袢利尿剂的给予呋塞米1.0 mg/kg,试验前7d内接受过袢利尿剂的给予呋塞米1.5 mg/kg).观察并记录给药后第1、2、3、4、5、6小时的尿量,随访28 d;根据患者是否进展至AKI 3级分为进展组和未进展组,用受试者工作特征曲线(ROC)分析FST对感染性休克患者早期AKI进展的预测价值.结果 无论FST前是否接受过利尿剂治疗,使用FST后未进展组每小时尿量均较进展组多(P＜0.05).FST后最初2h尿量预测早期AKI患者进展至AKI3级的ROC曲线下面积(AUC)为0.914(95％CI0.824～0.967),以170 mL为截取值,其敏感度和特异度分别为86.8％和88.2％.多因素Logistic回归分析显示,年龄、APACHEⅡ评分、血清乳酸水平、FST后最初2h尿量是影响预后的独立危险因素(P＜0.05).结论 FST后最初2h尿量对感染性休克AKI患者是否进展至AKI 3级具有较高的预测价值;年龄、APACHEⅡ评分、血清乳酸水平、FST后最初2h尿量是影响预后的独立危险因素.%Objective To investigate the prediction value of the furosemide stress test in the severity of early acute kidney injury (AKI) complicated by septic shock.Methods From February 2014 through December 2016,a total of 72 eligible patients who admitted to ICU and EICU in our hospital were enrolled in this prospective study.They were received a furosemide stress test (FST) (one-time dose of 1.0 or 1.5 mg/kg intravenous furosemide depending on prior furosemide-exposure)after adequate fluid resuscitation.The urine output following FST in each of the first 6 hours were recorded.The test was followed up for 28 days.According to stage 3 of AKI criteria,patients were divided into the progressor group and non-progressor group.The receiver operating characteristic curves were used to evaluate the prediction value of the furosemide stress test in the severity of acute kidney injury.Results Subjects with progressive AKI had significantly lower urine output following FST in each of the first 6 hours (P ＜ 0.05).The area under the receiver operator characteristic curves for the total urine output over the first 2 hours following FST to predict progression to stage 3 of AKI was 0.914 (95％ CI0.824 ～ 0.967),the sensitivity was 86.8％ and specificity was 88.2％ with a cutoff value of 170 mL.Age,APACHE Ⅱ score,blood lactate and urine output following FST in first 2 hours are the high risk factors affecting the prognosis (P ＜ 0.05).Conclusion The urine output following FST within the first 2 hours has a predictive value for in the severity of subjects with early AKI complicated by sepsis shock.Age,APACHE Ⅱ score,blood lactate and urine output following FST in first 2 hours are the high risk factors affecting the prognosis.