Clinical efficacy of PiCCO-guided fluid resuscitation combined with alprostadil in the treatment of septic shock-induced acute kidney injury

Abstract:

Objective：To observe the clinical efficacy of pulse-induced contour cardiac output（PiCCO）-guided fluid resuscitation combined with alprostadil in the treatment of acute kidney injury in patients with septic shock and to discuss its mechanism of renal protection. Methods：Sixty-four patients with septic shock who were admitted to the Intensive Care Unit of the Second Affiliated Hospital of Chongqing Medical University or Chongqing Traditional Chinese Medicine Hospital from 2015 to 2018 were enrolled and randomly divided into PiCCO monitoring group（P group） and PiCCO monitoring + alprostadil group（PA group），with 32 patients in each group. After achieving target blood pressure levels，the PA group was slowly given intravenous injection of alprostadil 10 μg + normal saline 100 ml bid for five days；the P group was given normal saline in the same way and at the same dose and speed as the PA group. The two groups were compared in terms of mean arterial pressure（MAP），global end-diastolic volume index（GEDVI），and systemic vascular resistance index（SVRI） after 6-hour resuscitation；serum levels of interleukin-6（IL-6） and tumor necrosis factor-alpha（TNF-α）； urine output，serum levels of creatinine and cystatin C（Cys-C），percentage of patients adopting contin－uous renal replacement therapy（CRRT） over 2 weeks，and 28-day mortality. Results：After 6-hour fluid resuscitation，there was no significant difference in MAP or SVRI between the two groups（P>0.05），while the central venous pressure and GEDVI were significantly lower in the PA group than in the P group（P<0.05）；after 72-hour fluid resuscitation，the PA group had significantly reduced serum levels of IL-6，TNF-α，and Cys-C（all P<0.05），but had significantly increased urine output（P<0.05）. There was no significant difference between the two groups in the percentage of patients adopting CRRT over 2 weeks or 28-day mortality（P>0.05）. Conclusion：PiCCO-guided fluid resuscitation combined with alprostadil shows a better effect in achieving the goal of early fluid resuscitation，but cannot reduce the percentage of patients adopting CRRT or mortality in the treatment of acute kidney injury in patients with septic shock.