能量多普勒超声对急性肾损伤的评估价值

Value of power Doppler ultrasound to evaluate acute kidney injury

目的探讨能量多普勒超声（PDU）对急性肾损伤（AKI）的评估价值。方法应用能量多普勒超声监测40例AKI患者的肾脏血流，并采用4级半定量法进行评分，按照PDU评分结果对患者进行分组，对比不同组间AKl分期、AKI持续时间的差异，并以患者是否死亡或CRRT时间〉3d为应变量应用多因素Logistic回归进行分析。结果40例AKI患者中PDU评分分别为1、2、3分，无0分患者。1、2和3分组分别有12、15、13例，3分组的ICU病死率和28d病死率均低于2分组和1分组；3分组中AKl分期3期人数少于2分组和1分组（分别为1、4、9例）[X2=16．103，自由度（df）：4，P=0．003]；3分组中持久性AKl人数少于2分组和1分组（分别为3、9、10例），差异有统计学意义（P〈0．05）；AKI患者年龄、APACHEII评分及肾脏能量多普勒超声评分（〈3分）与死亡结局密切相关（P〈0．05）；年龄、血肌酐值、APACHEII评分及肾脏能量多普勒超声评分（〈3分）与行长期持续肾脏替代治疗（CRRT）（〉3d）结局密切相关（P〈0．05）。结论PDU可用于AKI患者的肾脏血流动力学监测，并可根据PDU评分评估AKI的严重程度和预后。

Objective To explore the value of power Doppler ultrasound （PDU） in the evaluation of acute kidney injury （AKI）. Methods Renal blood flow of 40 AKI cases was monitored by power Doppler ultrasound and 4-level semiquantitative PDU score method employed. All cases were divided into 3 groups by PDU score. AKI stage and duration were compared. And the co-variables of death and （ continuous renal replacement therapy） CRRT days （ 〉 3 ） were also analyzed by Logistic regression analysis. Results A total of 40 AKI case were recruited. The 3-score group（ n = 13 ） has lower mortality in intensive care unit and at 28 days than the 2-score group （n = 15） and the 1-score group （n = 12）. The number of stage-3 AKI in the 3- score group was less than that in the 2-score and 1-score groups （n = 1,4, 9 correspondingly, X2 = 16. 103, degree of freedom = 4, P = 0. 003 ）. The number of persistent AKI in the 3-score group was less than that in the 2-score and 1 -score groups （ n = 3,9,10 correspondingly, P 〈 0.05 ）. Age, APACHE l] score and PDU score（ 〈3）were closely correlated with death while age, APACHE Ⅱ score, level of serum creatinine and PDU score（ 〈 3 ） with CRRT days （ 〉 3 ） （ P 〈 0. 05 ）. Conclusion PDU may be used to monitor renal hemodynamics in AKI patients and its score helps clinicians to evaluate the severity and prognosis of AKI.