早期液体复苏对脓毒性休克患者肾功能的影响

摘要

Objective To study the effect of early fluid resuscitation on renal function of the patients with septic shock by determining the neutrophil gelatinase - associated lipocalin ( NGAL) and cystatin C. Methods 48 patients with septic shock were admitted into the ICU of the 4th Affiliated Hospital of the Hebei Medical University during March 1 and November 11, 2010. According to the 2004 international guideline for the treatment of sepsis, fluid resuscitation was conducted through the emplaced deep venous catheter following the early goal directed therapy (EGDT). Blood samples were taken at 0 h before the fluid loading, and at 6, 24, 48 h after the fluid loading. The plasma NGAL and cystatin C were detected by the ELISA method. Meanwhile, the temperature, heart rate, respiration rate, mean arterial pressure, hourly - and 24 - hour urine volume, ScvO2 and the APACHE II score were simultaneously recorded. The subjects were further divided into survival and non - survival groups. The controls were 20 healthy volunteers. Results The plasma NGAL and cystatin C levels before fluid loading were statistically higher than those in the control ( P < 0. 01 or P < 0. 05 ) . The plasma NGAL and cystatin C levels were significantly lower at 24 h than those before the treatment ( P < 0. 01 ). The plasma cystatin C and NGAL level were statistically higher in the deceased group than in the survival group, but no statistical difference was detected in the plasma NGAL level ( P > 0. 05 ) . The correlation between the plasma NGAL, cystatin C levels and Scr was very good, and the plasma NGAL, Cystatin C levels step up earlier than Scr. Conclusion ①The plasma concentration of NGAL and cystatin C are clearly elevated in the patients with septic shock, which indicates the occurrence of acute kidney injury ( AKI). ② Early and complete fluid loading may markedly improve the renal function in the studied patients. ③The correlation between the plasma NGAL, cystatin C and Scr is very good, but the plasma NGAL and cystatin C could reflect the damage of the renal earlier, and the plasma concentration of the NGAL and cystatin C are positive correlation with damage of the renal.%目的 通过检测早期肾损伤监测指标血浆胱抑素C(Cystatin C)、中性粒细胞明胶酶脂质转运蛋白(NGAL),探讨早期液体复苏对脓毒性休克患者肾功能的影响.方法 收集自2010-03-01～2010-11-30本院ICU收治的脓毒性休克患者48例作为实验组,参照2004年国际脓毒症治疗指南的早期目标导向治疗(EGDT)进行液体复苏.分别于0、6、24、48 h 四个时间点用ELISA法测定血浆Cystatin C、NGAL浓度,同时记录患者体温、心率、呼吸、平均动脉压及每小时尿量和24小时尿量、CVP、ScvO2、APACHEⅡ评分,根据预后再分为死亡组和存活组;取健康志愿者20例为正常对照组.结果 实验组液体复苏前血浆Cystatin C、NGAL浓度明显高于对照组(P<0.01或P<0.05);实验组24 h血浆Cystatin C、NGAL浓度较液体复苏前明显下降(P<0.01);死亡组血浆Cystatin C、NGAL浓度较存活组明显升高,但NGAL两组比较差异无统计学意义;血浆Cystatin C和NGAL浓度与血肌酐浓度有很好的相关性,且血浆Cystatin C和NGAL浓度升高要明显早于血肌酐.结论 ①脓毒性休克患者存在急性肾损伤;②早期充分的液体复苏可以明显改善脓毒性休克患者的肾功能状态;③血浆Cystatin C和NGAL浓度能反映患者早期的肾损害,与肾损害程度呈正相关.