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[JAMA诊断检查解读]:全身性感染危重患者的血清肌酐
2018年12月13日 临床话题, 模拟诊室 暂无评论

JAMA Diagnostic Test Interpretation

November 16, 2018

Serum Creatinine in the Critically Ill Patient With Sepsis

Matthieu Legrand, John A. Kellum

JAMA. Published online November 16, 2018. doi:10.1001/jama.2018.16627

Case 病例

73-year-old man underwent esophageal resection for cancer. He had a history of hypertension that was treated with an angiotensin receptor blocker. Preoperative estimated glomerular filtration rate (GFR) was 98 mL/min/1.73 m2. On the second postoperative day, body temperature was 38.6°C. Chest x-ray revealed bilateral lung consolidations consistent with pneumonia. Blood pressure decreased from 145/72 mm Hg to 96/53 mm Hg with a heart rate of 105/min. The patient was admitted to the intensive care unit (ICU) with acute respiratory failure and was placed on mechanical ventilation. In the ICU, urine output was 50 mL over 3 hours. On day 3, he received 4.5 L of Ringer lactate over 12 hours. Laboratory values are shown in the Table.

一名73岁男性患者因食道癌接受手术。患者既往有高血压病史,服用血管紧张素受体阻滞剂。术前评估GFR为98 mL/min/1.73 m2。在术后第2天,患者体温38.6°C。胸片显示双肺实变,符合肺炎表现。血压从145/72 mm Hg 下降到 96/53 mm Hg,心率105/min。患者因呼吸功能衰竭收入ICU并接受机械通气。入住ICU后3小时尿量为50 mL。第3天,患者在12小时内输注4.5 L乳酸林格氏液。实验室检查结果见下表。

How Do You Interpret the Test Results From Day 3 Postoperatively at 3 am? 你如何解读术后第3天3AM的检查结果?

View Results

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