呋塞米负荷试验对急性肾损伤患者启动肾脏替代治疗的预测价值

doi:10.3969/j.issn.1002-1949.2018.07.005

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摘要目的探讨呋塞米负荷试验(FST)对急性肾损伤(AKI)患者启动肾脏替代治疗(RRT)的预测价值。方法纳入2016-07～2017-07兰州大学第一医院重症医学科收治的138例AKI患者，在RRT之前行FST，即静脉给予1.0 mg/kg呋塞米后记录第2小时尿量(FST-UO2h)，观察RRT后患者的肾功能变化(分为进展组和未进展组)和病死率。以FST-UO2h小于等于200 mL为FST阴性，利用ROC曲线评价FST-UO2h预测RRT后患者肾功能恶化的特异度和敏感度。结果进展组和未进展组患者RRT前的年龄、APACHEⅡ评分、SOFA评分等比较差异无统计学意义，进展组患者KDIGO Ⅱ期比例高于未进展组，且其住院时间和28 d病死率也高于未进展组。FST-UO2h预测RRT后肾功能恶化的ROC曲线下面积(AUC)(0.76±0.07,P=0.01)明显高于血肌酐（sCr）和中性粒细胞明胶酶相关载脂蛋白（NGAL）的AUC (分别为0.55±0.08,P=0.48和0.63±0.07,P=0.08)。结论若AKI患者FST为阴性，提示其肾功能可能恶化，应尽早启动RRT。

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	窦志敏
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关键词 ：呋塞米负荷试验(FST), 肾脏替代治疗(RRT), 急性肾损伤（AKI）, 预测价值

基金资助:甘肃省自然科学基金项目（1308RJZA240）；甘肃省中医药管理局科研课题（GZK-2015-39）

通讯作者: 李斌（1972-），男，硕士研究生，主任医师，副教授，E-mail:lynd0001@163.com。

作者简介: 窦志敏（1987-),男，硕士，主治医师，E-mail:douzhm@126.com。

引用本文:

窦志敏，李红，朱磊，李斌，刘健. 呋塞米负荷试验对急性肾损伤患者启动肾脏替代治疗的预测价值[J]. 中国急救医学, 2018, 38(7): 586-589.
Dou Zhi-min, Li Hong, Zhu Lei, Li Bin, Liu Jian. Predictive value of furosemide stress test in starting renal replacement therapy of patients with acute kidney injury. Chinese Journal of Critical Care Medicine, 2018, 38(7): 586-589.

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http://www.cnemergency.org.cn/CN/10.3969/j.issn.1002-1949.2018.07.005 或 http://www.cnemergency.org.cn/CN/Y2018/V38/I7/586

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