超声在重症全身性感染患者急性肾损害早期诊断中的意义

Ultrasound alteration of renal blood flow in sepsis-induced acute kidney injury

目的通过探测肾血流的超声变化,明确超声在重症全身性感染患者急性肾损害(AKI)早期诊断中的意义。方法选取2009年3月至2010年12月入住首都医科大学附属复兴医院重症监护病房(ICU)且首次诊断为重症全身性感染的31例患者,共计62只肾,于诊断后首个24h内,达到血流动力学稳定时,超声测量肾脏大小、肾脏上中下三极叶间动脉的收缩期峰值流速(Vmax)、舒张期峰值流速(Vmin)、阻力指数(RI)、肾血管搏动指数(PI)。常规实验室检测血肌酐(Scr)值。31例重症全身性感染患者中,根据第5天Scr水平诊断急性肾损害15例(AKI组),非急性肾损害16例(非AKI组)。第5天再次测量上述指标并进行对比分析。结果后期分析显示,AKI组肾叶间动脉RI值第1天即较非AKI组明显增高(0.721vs.0.696,P<0.01),而此时两组间Scr值差异并无统计学意义。结论通过超声检测肾叶间动脉RI值,可以为重症全身性感染患者早期诊断AKI提供客观依据。

Objective To find out the relationship between the alteration of the renal blood flow measured by ultrasound in the early stage of the severe sepsis and the following acute kidney injury(AKI).Methods 31 patients with severe sepsis from March 2009 to December 2010 in Intensive Care Unit(ICU)of Fuxing Hospital were included.After diagnosed as sepsis,the patients were surveyed with the size of kidney,renal arterial peak systolic velocity(Vmax),renal arterial peak diastolic velocity(Vmin),renal arterial resistance index(RI) and renal pulse index(PI) by ultrasound on the first day(D1)and the fifth day(D5)respectively.Results All the patients were classified into two groups according to the renal function:Group AKI(n=15) and Group non-AKI(n=16).On D1,RI of Group AKI was significantly higher than that of Group non-AKI(0.721 vs.0.696,P<0.01).Conclusions RI measured with ultrasound may be helpful to early diagnosis of AKI.