肾动脉阻力指数对脓毒症相关性急性肾损伤可逆性诊断的预测价值
摘要
目的评价肾动脉阻力指数(RRI)在重症脓毒症合并急性肾损伤(AKI)的患者可逆性诊断中的预测价值。方法选取收治的重症脓毒症合并感染性休克患者,根据是否出现持续性AKI分为两组,分别为短暂性AKI组和持续性AKI组。比较两组入院第1、3天肌酐值和RRI值。结果与入院第1天比较,短暂性AKI组入院第3天肌酐水平明显降低(P<0.05),持续性AKI组肌酐水平明显增高(P<0.05);持续性AKI组入院第3天肌酐水平较短暂性AKI组要高(P<0.01)。与入院第1天比较,入院第3天短暂性AKI组RRI水平明显降低(P<0.05),持续性AKI组RRI水平明显增高(P<0.05);入院第1、3天持续性AKI组RRI值均高于短暂性AKI组(P<0.05,P<0.01)。结论 RRI是简便无创的肾功能评价指标,RRI值能够更早地预测持久性AKI的发生风险,在脓毒症休克的患者中能够比较敏感和准确地识别出短暂性AKI和持续性AKI。
引文
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[2] Burri G,Trueb L,Marti C,et al.Emergency medicine:updates 2012[J].Rev Med Suisse,2013,9(368):57-61.
[3] Taillac P,Brocato C.Vital pathways:detect & treat symptoms related to hemorrhagic shock[J].JEMS,2012,37(10):64-70.
[4] Kelsey R.Acute Kidney injury:ultrasound may be useful in preventing acute kidney injury[J].Nat Rev Nephrol,2013,9 (10):556.
[5] 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.
[6] Lerolle N,Guérot E,Faisy C,et al.Renal failure in septic shock:predictive value of Doppler-based renal arterial resistive index[J].Intensive Care Med,2006,32(10):1553-1559.
[7] Hoyt K,Warram JM,Wang D,et al.Molecular ultrasound imaging of tissue inflammation using an animal model of acute kidney injury[J].Mol Imaging Biol,2015,17(6):786-792.
[8] Kellum JA,Lameire N,KDIGO AKI Guideline Work Group.Diagnosis,evaluation,and management of acute kidney injury:a KDIGO summary (Part 1)[J].Crit Care,2013,17 (1):204.
[9] 张晔,施乾坤,穆心苇.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] Dewitte A,Coquin J,Meyssignac B,et al.Doppler resistive index to reflect regulation of renal vascular tone during sepsis and acute kidney injury[J].Crit Care,2012,16 (5):R165.
[11] 施连东,高嵩,唐建华.非高血压非糖尿病肥胖患者肾叶间动脉阻力指数与微量白蛋白尿的关系[J].广东医学,2016,37(4):549-551.
[12] 王炼,姚绍球,杨斌,等.慢性肾病彩色多普勒血流图与肾皮质厚度及病理改变[J].中国超声医学杂志,2011,12(5):43-44.
[13] Platt JF,Rubin JM,Ellis JH.Acute renal failure:possible role of duplex Doppler US in distinction between acute prerenal failure and acute tubular necrosis[J].Radiology,1991,179(2):419-423.
[14] Darmon M,Schortgen F,Vargas F,et al.Diagnostic accuracy of Doppler renal resistive index for reversibility of acute kidney injury in critically ill patients[J].Intensive Care Med,2011,37(1):68-76.