ST段抬高型心肌梗死合并心源性休克患者体液正平衡与急性肾损伤的相关性研究

doi:10.3969/j.issn.1002-1949.2018.08.010

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摘要目的评价ST段抬高型心肌梗死（STEMI）合并心源性休克患者体液正平衡与急性肾损伤（AKI）的相关性。方法回顾性分析192例在安顺市人民医院心内科CICU治疗的STEMI合并心源性休克患者的临床资料。患者均进行体液管理治疗，根据入院后96 h是否存在累积液体正平衡，将患者分为两组，即液体正平衡组（n=99）与液体负平衡组（n=93）。比较两组患者24、48、72和96 h的液体平衡情况及96 h时累积液体入量和出量，比较两组患者AKI发生率、血肌酐（SCr）变化及AKI恢复患者的比例。采用Pearson检验评价液体平衡量与相关变量间的关系；采用多元Logistic回归模型评价AKI恢复的独立预测因子。结果在入院24、48、72和96 h，液体正平衡组液体平衡量均明显高于液体负平衡组（均P＜0.001），同时液体正平衡组累计液体输入量明显高于液体负平衡组（t=16.543，P＜0.001），影响液体平衡的主要因素是液体正平衡组患者治疗过程中液体输入较多，而非液体输出较少。与液体负平衡组比较，液体正平衡组患者AKI 2～3期的发生率更高［51.7%（31/60） vs. 12.5%（7/56）， χ2=20.172，P＜0.001］，肾功能恢复比例更低［28.3%（17/60） vs. 75.0%（42/56）， χ2=25.240，P＜0.001］。液体正平衡患者的液体平衡量与SCr变化值呈正相关（r=0.432，P=0.005），液体正平衡量与患者肾功能恢复可能性降低密切相关。结论 STEMI合并心源性休克的患者液体正平衡与肾功能严重恶化、肾功能恢复可能性降低密切相关。

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关键词 ：体液平衡, 心力衰竭, 休克, 急性肾损伤（AKI）, ST段抬高型心肌梗死（STEMI）, 心源性休克

作者简介: 詹鹏（1970-），男，副主任医师，E-mail:zhanpeng325@163.com。

引用本文:

詹鹏，徐磊，杨天和，张云东. ST段抬高型心肌梗死合并心源性休克患者体液正平衡与急性肾损伤的相关性研究[J]. 中国急救医学, 2018, 38(8): 690-694.
Zhan Peng, Xv Lei, Yang Tian-he. The Research on the Correlation between Positive Fluid Balance and Acute Kidney Injury in Patients with ST-segment Elevation Myocardial Infarction Complicated by Cardiogenic Shock. Chinese Journal of Critical Care Medicine, 2018, 38(8): 690-694.

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http://www.cnemergency.org.cn/CN/10.3969/j.issn.1002-1949.2018.08.010 或 http://www.cnemergency.org.cn/CN/Y2018/V38/I8/690

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