摘要目的 评价感染性休克患者液体复苏后10 min氧负荷试验对急性肾损伤(acute kidney injury,AKI)发病率及评估预后的意义.方法 回顾性分析解放军第一八一医院2014年1月至2017年12月收治的感染性休克患者58例的临床资料,在液体复苏开始前(T0)、液体复苏6 h(T1)进行10min氧负荷试验计算出10 min氧负荷值,并以T1时10 min氧负荷值分组:10 min氧负荷值≥66mmHg(1 mmHg=0.133 kPa)设为高负荷组(26例),＜66 mmHg设为低负荷组(32例).记录两组T0、T1时10 min氧负荷值、血流动力学与全身氧代谢指标、血管活性药物用量以及AKI发病率、AKI分期、连续性肾脏替代治疗、ICU与28 d病死率等,并用COX回归模型检验患者预后相关影响因素.结果 高负荷组AKI发病率[50.0％(13/26)与78.1％(25/32),x2=6.365]、AKI 3期[26.9％ (7/26)与53.1％(17/32),x2=8.016]、接受肾脏替代治疗比例[23.1％(6/26)与46.9％(15/32),x2=5.764]均较低负荷组明显降低(P均＜0.05),且ICU病死率[23.1％ (6/26)与53.1％(17/32),x2=7.134]、28 d病死率[30.8％ (8/26)与62.5％(20/32),x2=6.067]亦较低负荷组明显降低(P均＜0.05).6h10 min氧负荷值≥66 mmHg均是ICU死亡(RR=0.013,95％CI:0.021～0.396,P均＜0.05)与28 d死亡(RR=0.018,95％CI:0.009～0.280,P均＜0.05)的保护因素.结论 10 min氧负荷值可作为感染性休克致AKI的发病率、严重度及评估预后一项可靠指标,10 min氧负荷试验有助于优化该类患者的治疗.

abstractsObjective To evaluate the significance of oxygen stress test in 10 minutes after fluid resuscitation in the incidence and prognosis of acute kidney injury (AKI) in septic shock patients.Methods From January 2014 to December 2017,fifty-eight patients with septic shock were enrolled.The 10 min oxygen challenge test was conducted using transcutaneous oximetry just before (T0) and 6 h (T1) after initiation of fluid resuscitation,and 10 min oxygen challenge test data(10 min OCT) at TO and T1 were then calculated,respectively.The enrolled patients were divided into L group (10 min OCT＜66 mmHg,32 cases) and H group (10 min OCT ≥66 mmHg,26 cases)according to the 10 min OCT value at T1.The hemodynamic variables and oxygen metabolism indexes,dose of vasoactive agents,10 min OCT at T0 and T1 were recorded,incidence and severity of septic shock-associated AKI,frequency of continuous renal replacement therapy,ICU mortality and 28 d mortality were compared between two groups,the risk factors associated with prognosis were analyzed using COX regression model.Results The hemodynamic variables and oxygen metabolism indexes and dose of vasoactive agents were comparable between two groups at TO and T1 (P ＜ 0.05).The incidence of septic shock-associated AKI (78.1％ (25/32) vs.50.0％ (13/26),x2 =6.365),proportion of phase 3 AKI (53.1％ (17/32) vs.26.9％ (7/26),x2 =8.016) and frequency of continuous renal replacement therapy (46.9％ (15/32) vs.23.1％ (6/26),x2 =5.764) was higher in L group than those in H group(P＜0.05),and similarly were the ICU mortality (23.1％ (6/26)vs.53.1％ (17/32),x2 =7.134,P ＜ 0.05) and 28 d mortality (30.8％ (8/26) vs.62.5％ (20/32),x2 =6.067,P ＜0.05).Therefore,the 6 h 10 min OCT≥66 mmHg was a protective factor to improve the ICU mortality(RR =0.013,95％CI:0.021-0.396,P＜0.05) and 28 d mortality(RR=0.018,95％CI:0.009-0.280,P＜0.05) in patients with septic shock-associated AKI.Conclusion 10 min OCT imposes substantial imquence on the incidence,severity and prognosis of patients with septic shock-associated AKI,oxygen challenge test could improve the treatment of septic shock-associated AKI.