危重患者的速尿应激试验、电解质反应及肾指数

危重患者的速尿应激试验、电解质反应及肾指数

贵州医科大学  麻醉与心脏电生理课题组

翻译:李奕    编辑：马艳燕   审校：曹莹

背景：急性肾损伤（AKI）是危重患者的常见综合征。传统标志物（如血清肌酐）的诊断能力最近受到质疑，并提出了使用新的检测，如速尿应激试验或超声评估肾阻力指数。本研究的目的是比较接受机械通气治疗的患者（入院时有或无急性肾损伤，以及在第三天出现或未出现AKI的患者）对呋塞米应激试验的反应、肾指数，以及在接受ICU治疗时肾功能正常的患者。

方法：对普通重症监护室连续机械通气患者的前瞻性观察研究。入院时进行呋塞米应激试验和超声肾指数，并收集临床和实验室数据。

结果：纳入40名患者，其中19人入院时患有AKI。AKI患者的肾指数显著升高（0.77±0.07 vs.0.72±0.08，P=0.027）；AKI患者在呋塞米应激试验后尿量显著降低（400[340；1400]vs.1525[400；2550]ml；P=0.013）。患有和不患有AKI的患者在呋塞米应激试验前后血浆钠、钾和氯的浓度没有差异，与无AKI的患者相比，钾和氯化物显著降低。在入院时没有AKI的患者中发现了类似的结果，与没有出现AKI患者相比，在第三天出现了AKI。

结论：速尿应激试验和肾指数可作为评估危重患者肾功能的附加工具。

原始文献来源：Luca Bolgiaghi , Michele Umbrello , Paolo Formenti, et al. The furosemide stress test, electrolyte response and Renal Index in critically ill patients.[J].Minerva Anestesiol. 2021 Apr;87(4):448-457.

英文原文：

The furosemide stress test, electrolyte response

and Renal Index in critically ill patients

Background:Acute kidney injury (AKI) is a common syndrome in critically ill patients. The diagnostic ability of traditional markers such as serum creatinine has recently been questioned, and the use of newer tests such as the furose- mide stress test or the ultrasound assessment of renal resistive index have been proposed. Aim of the present study was to compare the response to a furosemide stress test, the Renal Index in mechanically ventilated patients with and without acute kidney injury at admission, and who did or did not develop AKI at day three, among those with normal renal function at the CIU admission.

Method:Prospective observational study in consecutive mechanically ventilated patients admitted in a general inten- sive care. Furosemide stress test and ultrasonographical Renal Index were performed at the admission and clinical and laboratory data were collected before and two hours after the furosemide stress text. The urine output after the first and the second hours was recorded.

Results:Forty patients were enrolled, 19 of whom had AKI at admission. The Renal Index was significantly higher in patients with AKI (0.77±0.07 vs. 0.72±0.08, P=0.027); patients with AKI had a significantly lower urine output after

the furosemide stress test (400 [340; 1400] vs.1525 [400; 2550] mL; P=0.013). The plasma concentrations of sodium, potassium and chloride were not different before and after the furosemide stress test in patients with and without AKI, whereas in patients with AKI, the total urine output of sodium, potassium and chloride were significantly lower compared to patients without AKI. Similar results were found in patients without AKI at admission and who developed AKI at day three as compared to those who did not develop AKI.

Conclusion:The response to the furosemide stress test and the Renal Index could be used as additional tools to evaluate the kidney function in critically ill patients.

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