血管外肺水指数用于判断连续肾脏替代介入时机的临床研究

摘要

Objective To explore the application of using pulse index continuous cardiac output (PICCO) technology to monitor extravascular lung water index (EVLWI) in judging the timing of continuous renal replacement therapy for non‐acute kidney injury patients .Methods The clinical data of the patients with non‐acute kidney injury from January 2014 to July 2015 were analyzed .The patients were divided into continuous renal replacement therapy (CRRT) group and non‐CRRT group .Logistic analysis was used to determine whether central venous pressure (CVP) ,cardiac output (CO) ,cardiac index (CI) ,systemic vascular resistance index (SVRI) ,stroke volume variation (SVV) and EVLWI influenced the CRRT .And the area under curve (AUC) of these indicators were also analyzed .Results EVLWI was the only indicator influenced CRRT (OR=9 .959 ,95% CI:6 .193-16 .015) .AUC of EV‐LWI was 0 .939 (95% CI:0 .915-0 .964) .Conclusion EVLWI ,one of the indicators detected by PICCO ,can be applied to deter‐mine the timing of CRRT intervention in patients with non‐acute renal injury .If the EVLWI value is higher than 9 .96 mL/kg ,the CRRT should be started immediately .%目的：探讨在非急性肾损患者治疗中，将脉搏指示连续心排量检测技术（PICCO ）监测到的血管外肺水指数（EVL‐WI）应用于判断连续肾脏替代介入时机的指导意义。方法回顾性分析2014年1月至2015年7月该院重症科使用PICCO技术监测EVLWI的非急性肾损伤患者临床资料，将患者分为连续肾脏替代治疗组（CRRT ）和非CRRT组，通过Logistic分析和受试者工作特征（ROC）曲线分析两组患者中心静脉压（CVP），心输出量（CO），心脏指数（CI），体循环血管阻力指数（SVRI），每搏量变异度（SVV），EVLWI对CRRT治疗的影响及曲线下面积（AUC）。结果 EVLWI为CRRT 治疗的影响因素（OR＝9．959，95％CI：6．193～16．015），其AUC为0．939，95％ CI为0．915～0．964。结论 PICCO技术监测的EVLWI ，可用于判断在非急性肾损伤患者中CRRT介入时机，EVLWI大于9．96 mL／kg应立即开始CRRT治疗。