彩色多普勒超声在肾移植后监测中的应用

Valuation of color Doppler ultrasound in monitoring hemodynamic parameters following renal transplantation

背景:超声检查已经成为了肾移植后的常规检查及监测方法。目的:探讨彩色多普勒超声在肾移植后监测的应用价值。方法:对61例同种异体肾移植后患者采用彩色多普勒超声进行检测,其中移植肾正常组35例,急性排斥反应组22例,慢性排斥反应组4例。对所有患者进行常规超声探查,结合彩色多普勒及能量多普勒观察移植肾的观察移植肾结构、血流灌注情况,测量各级血管的血流参数。结果与结论:急性排斥反应组移植肾较功能正常组明显肿大,彩色多普勒显像、多普勒能量图显示肾实质血流信号减少,舒张期明显,各级动脉阻力指数和搏动指数明显增高;慢性排斥反应组移植肾体积较功能正常组明显减小,彩色多普勒显像、多普勒能量图显示肾动脉内径明显缩小,动脉阻力指数和搏动指数明显升高。提示,应用超声能早期无创的观察移植肾的血流灌注情况,测量移植肾各级血管的血流参数能敏感的反应移植肾的功能状况。

BACKGROUND:Ultrasound examination has been a routine examination and monitoring method following renal transplantation. OBJECTIVE:To investigate the value of color Doppler ultrasound in monitoring hemodynamic parameters of the transplanted kidney. METHODS:Sixty-one patients of allograft renal transplantation were divided into 3 groups of which 35 patients in normal group, 22 in acute rejection group, and 4 in chronic rejection group. Conventional ultrasound examination combined with color Doppler flow image (CDFI) and power Doppler image (PDI) was performed with each objects to observe construction, blood perfusion and measure the hemodynamic parameters of various vessels in transplanted kidney. RESULTS AND CONCLUSION:Swelling, renal parenchyma thickening and echo enhancement were demonstrated in acute rejection group. The bound between cortex and medullary substance was blurring. CDFI and PDI indicated that the blood signal was reduced in renal parenchyma, especially in relaxing period. The peak of frequency spectrum of renal arterial vessels was high in systole period, but less spectrum or no signals in relaxing period, even some seemed singlet. The resistance index (RI) and pulsatility index (PI) rose up obviously in different vessels. The kidney turned to be small, echo enhancement and the bound was not clear in chronic rejection group. CDFI and PDI showed the internal diameter was decreased;vessel branches were rare and interrupted. The flow rate was apparently descent both in relaxing and systole periods. The priming volume was reduced RI and PI obviously heightened. As a non-invasive method, ultrasound can be used in early observation of the blood perfusion of the transplanted kidney without trauma. The function status of the kidney could be relaxed by measuring hemodynamic parameters of different vessels.