彩色多普勒超声联合肾功能检查对重症医院感染患者急性肾损伤的诊断价值
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摘要
目的探究彩色多普勒超声联合肾功能检查对重症医院感染患者急性肾损伤的诊断价值。方法选择2014年6月-2016年6月医院收治的76例重症医院感染患者为研究对象。所有患者均联合彩色多普勒超声及肾功能检查,将判断急性肾损伤结果与确诊结果对比,判断该方法的诊断效能。结果 76例重症医院感染患者中,行血培养共培养分离病原菌94株,其中革兰阳性菌30株占31.91%,革兰阴性菌57株占60.64%,真菌7株占7.45%。共确诊51例急性肾损伤,且不同感染类型患者发生急性肾损伤率分别为呼吸系统72.50%(29/40)、消化系统66.67%(14/21)、泌尿系统62.50%(5/8)、其他42.86%(3/7),差异无统计学意义(P=0.827);彩色多普勒超声联合肾功能检查共发现30例急性肾损伤,阳性预测值为90.00%、敏感度为77.14%、特异度为81.25%。急性肾损伤患者肾横径、肾长径及肾实质厚度与无急性肾损伤患者差异无统计学意义,但肾叶间动脉PI及肾叶间动脉RI分别为(1.39±0.06)及(0.72±0.08)高于无急性肾损伤者(P<0.001)。结论重症医院感染患者以革兰阴性菌感染多见,且易伴发急性肾损伤。联合彩色多普勒超声及肾功能检查有助于早期发现重症医院感染合并急性肾损伤,具有较好的诊断价值。
OBJECTIVE To explore diagnostic value of color Doppler ultrasonography combined with renal function test in acute renal injury in patients with critical nosocomial infections.METHODS 76 patients admitted with critical nosocomial infections from Jun.2014 to Jun.2016 were selected as subjects.All patients were examined by color Doppler ultrasonography combined with renal function tests,and the results of acute renal injury were compared with the diagnosis results,to judge the diagnostic effectiveness of this method.RESULTS Among 76 patients with severe nosocomial infections,94 strains of pathogens were isolated from blood culture.Among them,30 strains of gram-positive bacteria accounted for 31.91%,57 strains of gram-negative bacteria accounted for 60.64%,and 7 strains of fungi accounted for 7.45%.51 cases of acute renal injury were confirmed,and the incidence of acute renal injury in infection of respiratory system was 72.50%(29/40),and the acute renal injury incidences in infection of digestive system,urinary system and other types of infection were 66.67%(14/21),62.50%(5/8),and 42.86%(3/7),respectively.The difference was not significant(P=0.827).30 cases of acute renal injury were found by color Doppler ultrasonography combined with renal function examination,the positive predictive value was 90.00%,the sensitivity was 77.14%and the specificity was 81.25%.No significant difference was found in kidney diameter,kidney diameter and renal parenchyma thickness between patients with or without acute renal injury.But the interlobular arterial PI and interlobular artery RI of patients with critical nosocomial infections combined with acute renal injury were(1.39±0.06)and(0.72±0.08),respectively,which were significantly higher than those without acute renal injury(P<0.001).CONCLUSIONPatients with critical nosocomial infections is more common with gram-negative bacteria infection and easily associated with acute renal injury.Combined color Doppler ultrasonography and renal function tests can help early detection of critical nosocomial infections combined with acute renal injury,which has a good diagnostic value for clinical use of detection.
OBJECTIVE To explore diagnostic value of color Doppler ultrasonography combined with renal function test in acute renal injury in patients with critical nosocomial infections.METHODS 76 patients admitted with critical nosocomial infections from Jun.2014 to Jun.2016 were selected as subjects.All patients were examined by color Doppler ultrasonography combined with renal function tests,and the results of acute renal injury were compared with the diagnosis results,to judge the diagnostic effectiveness of this method.RESULTS Among 76 patients with severe nosocomial infections,94 strains of pathogens were isolated from blood culture.Among them,30 strains of gram-positive bacteria accounted for 31.91%,57 strains of gram-negative bacteria accounted for 60.64%,and 7 strains of fungi accounted for 7.45%.51 cases of acute renal injury were confirmed,and the incidence of acute renal injury in infection of respiratory system was 72.50%(29/40),and the acute renal injury incidences in infection of digestive system,urinary system and other types of infection were 66.67%(14/21),62.50%(5/8),and 42.86%(3/7),respectively.The difference was not significant(P=0.827).30 cases of acute renal injury were found by color Doppler ultrasonography combined with renal function examination,the positive predictive value was 90.00%,the sensitivity was 77.14%and the specificity was 81.25%.No significant difference was found in kidney diameter,kidney diameter and renal parenchyma thickness between patients with or without acute renal injury.But the interlobular arterial PI and interlobular artery RI of patients with critical nosocomial infections combined with acute renal injury were(1.39±0.06)and(0.72±0.08),respectively,which were significantly higher than those without acute renal injury(P<0.001).CONCLUSIONPatients with critical nosocomial infections is more common with gram-negative bacteria infection and easily associated with acute renal injury.Combined color Doppler ultrasonography and renal function tests can help early detection of critical nosocomial infections combined with acute renal injury,which has a good diagnostic value for clinical use of detection.
引文
[1]刘彬森.连续性肾脏替代治疗重症感染引起急性肾损伤的疗效观察[J].基层医学论坛,2017,21(31):4314-4315.
[2]Bossard G,Bourgoin P,Corbeau JJ,et al.Early detection of postoperative acute kidney injury by Doppler renal resistive index in cardiac surgery with cardiopulmonary bypass[J].Br J Anaesth,2011,107(6):891-898.
[3]黄盈,黄月,何颖,等.肾脏彩超对重症患者并发急性肾损伤预测价值分析[J].河北医学,2017,23(5):823-825.
[4]陈九军,刘玉,陈云超,等.重症感染患者急性肾损伤的超声早期诊断评价[J].中华医院感染学杂志,2014,24(13):3253-3254.
[5]方丽妮,冯岚,陶阳,等.彩色多普勒超声用于重症感染急性肾损伤的诊断价值[J].中华医院感染学杂志,2017,27(16):3673-3676.
[6]中华人民共和国卫生部.医院感染诊断标准(试行)[J].中华医学杂志,2001,81(5):314-320.
[7]RL Mehta,JA Kellum,S Shah,等.急性肾损伤诊断与分类专家共识[J].中华肾脏病杂志,2006,22(11):661-663.
[8]Marty P,Szatjnic S,Ferre F,et al.Doppler renal resistive index for early detection of acute kidney injury after major orthopaedic surgery:aprospective observational study[J].Eur J Anaesthesiol,2015,32(1):37-43.
[9]张晔,施乾坤,穆心苇,等.超声诊断重症患者急性肾损伤的新进展[J].中华危重症医学杂志(电子版),2014,7(2):135-139.
[10]Le Dorze M,BougléA,Deruddre S,et al.Renal Doppler ultrasound:a new tool to assess renal perfusion incritical illness[J].Shock,2012,37(4):360-365.
[11]谭新章,邵义明.超声影像学早期诊断急性肾损伤的研究进展[J].中外医学研究,2016,14(15):161-163.
[12]武宏敏,杨莉.急性肾损伤的早期诊断和治疗进展[J].中国血液净化,2015,14(7):388-391.
[13]葛肖艳,曾艾,张伟,等.重症全身性感染患者急性肾损害超声早期诊断的临床评价[J].中华医院感染学杂志,2016,26(8):1712-1714.
[14]Meola M,Petrucci I.Ultrasound and color Doppler in nephrology.Acute kidney injury[J].G Ital Nefrol,2012,29(5):599-615.
[15]Zolfaghari A,Ghadirpour A,Tarzamni MK,et al.Renal vascular Doppler resistance after extracorporeal shock wave lithotripsy[J].Ren Fail,2013,35(5):686-690.
[16]侯超,李明星.超声造影评价急性肾损伤患者肾血流灌注的应用现状[J].东南大学学报(医学版),2017,36(2):264-267.
[2]Bossard G,Bourgoin P,Corbeau JJ,et al.Early detection of postoperative acute kidney injury by Doppler renal resistive index in cardiac surgery with cardiopulmonary bypass[J].Br J Anaesth,2011,107(6):891-898.
[3]黄盈,黄月,何颖,等.肾脏彩超对重症患者并发急性肾损伤预测价值分析[J].河北医学,2017,23(5):823-825.
[4]陈九军,刘玉,陈云超,等.重症感染患者急性肾损伤的超声早期诊断评价[J].中华医院感染学杂志,2014,24(13):3253-3254.
[5]方丽妮,冯岚,陶阳,等.彩色多普勒超声用于重症感染急性肾损伤的诊断价值[J].中华医院感染学杂志,2017,27(16):3673-3676.
[6]中华人民共和国卫生部.医院感染诊断标准(试行)[J].中华医学杂志,2001,81(5):314-320.
[7]RL Mehta,JA Kellum,S Shah,等.急性肾损伤诊断与分类专家共识[J].中华肾脏病杂志,2006,22(11):661-663.
[8]Marty P,Szatjnic S,Ferre F,et al.Doppler renal resistive index for early detection of acute kidney injury after major orthopaedic surgery:aprospective observational study[J].Eur J Anaesthesiol,2015,32(1):37-43.
[9]张晔,施乾坤,穆心苇,等.超声诊断重症患者急性肾损伤的新进展[J].中华危重症医学杂志(电子版),2014,7(2):135-139.
[10]Le Dorze M,BougléA,Deruddre S,et al.Renal Doppler ultrasound:a new tool to assess renal perfusion incritical illness[J].Shock,2012,37(4):360-365.
[11]谭新章,邵义明.超声影像学早期诊断急性肾损伤的研究进展[J].中外医学研究,2016,14(15):161-163.
[12]武宏敏,杨莉.急性肾损伤的早期诊断和治疗进展[J].中国血液净化,2015,14(7):388-391.
[13]葛肖艳,曾艾,张伟,等.重症全身性感染患者急性肾损害超声早期诊断的临床评价[J].中华医院感染学杂志,2016,26(8):1712-1714.
[14]Meola M,Petrucci I.Ultrasound and color Doppler in nephrology.Acute kidney injury[J].G Ital Nefrol,2012,29(5):599-615.
[15]Zolfaghari A,Ghadirpour A,Tarzamni MK,et al.Renal vascular Doppler resistance after extracorporeal shock wave lithotripsy[J].Ren Fail,2013,35(5):686-690.
[16]侯超,李明星.超声造影评价急性肾损伤患者肾血流灌注的应用现状[J].东南大学学报(医学版),2017,36(2):264-267.
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