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[Chest最新论文]:强化尿量监测与更多发现急性肾损伤及预后改善相关
2017年12月06日 时讯速递, 进展交流 暂无评论

Intensive Monitoring of Urine Output Is Associated With Increased Detection of Acute Kidney Injury and Improved Outcomes

Kui Jin, Raghavan Murugan, Florentina E. Sileanu, et al.

Chest 2017; 152: 972-979

Background 背景

Urine output (UO) is a vital sign for critically ill patients, but standards for monitoring and reporting vary widely between ICUs. Careful monitoring of UO could lead to earlier recognition of acute kidney injury (AKI) and better fluid management. We sought to determine if the intensity of UO monitoring is associated with outcomes in patients with and those without AKI.

尿量(UO)是危重病患者的重要生命体征,但ICU之间UO监测及报告差异很大。仔细监测UO可能更早发现急性肾损伤(AKI),并进行更好的液体治疗。我们试图确定UO监测强度与AKI及非AKI患者预后的相关性。

Methods 方法

This was a retrospective cohort study including 15,724 adults admitted to ICUs from 2000 to 2008. Intensive UO monitoring was defined as hourly recordings and no gaps > 3 hours for the first 48 hours after ICU admission.

这是一项回顾性队列研究,包括2000年至2008年间收入ICU的15724名成年患者。强化UO监测定义为收入ICU后最初48小时内每小时记录UO,且间隔不超过3小时。

Results 结果

Intensive monitoring for UO was conducted in 4,049 patients (26%), and we found significantly higher rates of AKI (OR, 1.22; P < .001) in these patients. After adjustment for age and severity of illness, intensive UO monitoring was associated with improved survival but only among patients experiencing AKI. With or without AKI, patients with intensive monitoring also had less cumulative fluid volume (2.98 L vs 3.78 L; P < .001) and less fluid overload (2.49% vs 5.68%; P < .001) over the first 72 hours of ICU stay.

4049名患者(26%)接受强化UO监测,我们发现这些患者AKI比例显著升高(OR, 1.22; P < .001)。对年龄和疾病严重程度进行校正后,强化UO监测伴随生存率改善,但仅限于AKI患者。无论是否合并AKI,接受强化UO监测患者在收入ICU的最初72小时内累积液体平衡更少(2.98 L vs 3.78 L; P < .001) ,液体负荷过多的程度较轻 (2.49% vs 5.68%; P < .001)。

Conclusions 结论

In this large ICU population, intensive monitoring of UO was associated with improved detection of AKI and reduced 30-day mortality in patients experiencing AKI, as well as less fluid overload for all patients. Our results should help inform clinical decisions and ICU policy about frequency of monitoring of UO, especially for patients at high risk of AKI or fluid overload, or both.

在这个大样本ICU患者研究中,强化UO监测伴随发现AKI更多,且AKI患者30天病死率降低,所有患者液体负荷过多情况较轻。我们的结果有助于进行临床决策及制定ICU中UO监测频率的相关政策,尤其是发生AKI和(或)液体负荷过多的高危患者。

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