Changes in Volumetric Hemodynamic Parameters Induced by Fluid Removal on Hemodialysis in Critically Ill Patients
Changes in Volumetric Hemodynamic Parameters Induced by Fluid Removal on Hemodialysis in Critically Ill Patients
复制标题
危重患者血液透析排液引起的血流动力学参数变化
DOI：
10.1111/1744-9987.12193
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发表时间：
2015
影响因子：
1.9
通讯作者：
T. Westhoff
中科院分区：
文献类型：
--
作者：
F. Compton;M. Vogel;W. Zidek;M. Giet;T. Westhoff
管理容量状态是困难的危重患者肾功能衰竭。体积血流动力学指标越来越多地被用于指导重症监护室（ICU）的液体治疗，但尚未建立用于监测危重患者血液透析诱导的液体清除。采用容量血流动力学监测方法，对35例ICU患者血液透析前后血管外肺水指数（EVLWI）和胸内血容量指数（ITBVI）的变化进行了测量。同时记录其他血液动力学和氧合相关参数，并在线监测血液透析期间的相对血容量（RBV）。除液后EVLWI显著降低（中位数10.0 vs. 9.6 mL/kg, P = 0.001），而ITBVI保持稳定（中位数1012 vs. 1029 mL/m2, P = 0.402）。卒中容积变化（中位数12.0 vs. 13.0%, P = 0.012）、心脏指数（中位数4.2 vs. 3.5 mL/min/m2, P = 0.003）、平均动脉压（中位数77 vs. 85.5 mmHg, P = 0.006）、去甲肾上腺素剂量（中位数0.092 vs. 0.114 μg/kg /min, P = 0.043）和血红蛋白值（中位数9.5 vs. 10.4 gm/dL, P = 0.036）也发生了显著变化。RBV下降7.8%（中位数）；与容积测量或记录的其他血流动力学参数没有相关性。透析降低EVLWI反映了多余体液的清除，而保留心脏预负荷则表明ITBVI的稳定性。体积血流动力学测量提供了关于液体状态的额外信息，因此可能有助于指导危重患者血液透析中的液体清除。
Management of volume status is difficult in critically ill patients with renal failure. Volumetric hemodynamic indices are increasingly being used to guide fluid therapy in the intensive care unit (ICU), but are not established to monitor hemodialysis‐induced fluid removal in critically ill patients. Using volumetric hemodynamic monitoring, changes in extravascular lung water index (EVLWI) and intrathoracic blood volume index (ITBVI) were measured immediately before and after hemodialysis sessions in 35 ICU patients. Additional hemodynamic and oxygenation related parameters were recorded at the same time, and online relative blood volume (RBV) monitoring was performed during hemodialysis. EVLWI decreased significantly with fluid removal (median 10.0 vs. 9.6 mL/kg, P = 0.001), whereas ITBVI remained stable (median 1012 vs. 1029 mL/m2, P = 0.402). Significant changes were also observed in stroke volume variation (median 12.0 vs. 13.0 %, P = 0.012), cardiac index (median 4.2 vs. 3.5 mL/min/m2, P = 0.003), mean arterial pressure (median 77 vs. 85.5 mmHg, P = 0.006), norepinephrine dose (median 0.092 vs. 0.114 μg/kg per min, P = 0.043), and hemoglobin values (median 9.5 vs. 10.4 gm/dL, P = 0.036). RBV decreased by 7.8% (median); there was no correlation with either the volumetric measurements or the other hemodynamic parameters recorded. EVLWI reduction with dialysis reflects the removal of excess body fluid, whereas preservation of cardiac preload is indicated by ITBVI stability. Volumetric hemodynamic measurements provide additional information concerning fluid status and are thus potentially useful to guide fluid removal on hemodialysis in critically ill patients.