relation between mean arterial pressure and renal function in the early phase of shock a prospective, explorative cohort study平均动脉压与肾功能的关系在早期阶段的潜在冲击,探险的队列研究.pdfVIP

Badin et al. Critical Care 2011, 15:R135 /content/15/3/R135 RESEARCH Open Access Relation between mean arterial pressure and renal function in the early phase of shock: a prospective, explorative cohort study 1 1* 2 1 1 2 Julie Badin , Thierry Boulain , Stephan Ehrmann , Marie Skarzynski , Anne Bretagnol , Jennifer Buret , 1 2 1 2 1 Dalila Benzekri-Lefevre , Emmanuelle Mercier , Isabelle Runge , Denis Garot , Armelle Mathonnet , Pierre-François Dequin2 and Dominique Perrotin2 Abstract Introduction: Because of disturbed renal autoregulation, patients experiencing hypotension-induced renal insult might need higher levels of mean arterial pressure (MAP) than the 65 mmHg recommended level in order to avoid the progression of acute kidney insufficiency (AKI). Methods: In 217 patients with sustained hypotension, enrolled and followed prospectively, we compared the evolution of the mean arterial pressure (MAP) during the first 24 hours between patients who will show AKI 72 hours after inclusion (AKIh72) and patients who will not. AKIh72 was defined as the need of renal replacement therapy or “Injury” or “Failure” classes of the 5-stage RIFLE classification (Risk, Injury, Failure, Loss of kidney function, End-stage renal disease) for acute kidney insufficiency using the creatinine and urine output criteria. This comparison was performed in four different subgroups of patients according to the presence or not of AKI at the sixth hour after inclusion (AKIh6 as defined as a serum creatinine level above 1.5 times baseline value within the first six hours) and the presence or not of septic shock