超声造影监测儿童及婴幼儿体外循环下肾脏微循环灌注的初探

Monitoring Renal Microcirculation Perfusion Alteration with Contrast-enhanced Ultrasound during Cardiopulmonary Bypass

目的探讨采用超声微泡造影方法监测儿童及婴幼儿体外循环下肾脏微循环灌注的改变。方法建立体外循环30min后,采用实时谐波超声造影技术获取肾脏超声微血管造影图像,分析肾脏不同区域灌注时间-强度(TIC)曲线,获取相关定量参数,包括上升支斜率(A)、曲线下面积(AUC)、曲线峰值强度绝对值(DPI)、达峰时间(TTP),比较不同采集时间点、不同区域灌注相关参数差异。结果体外循环期间肾脏各个区域(髓质锥体、深层皮质及浅层皮质区域)灌注参数相对于体外循环前均降低或延长(P<0.05)。结论体外循环对儿童肾脏灌注产生明显的影响,其表现为全肾灌注降低及局部灌注性差异,以髓质区域的灌注降低最为明显。超声微泡造影技术能够清晰地显示体外循环期间肾脏微循环灌注功能状态的改变。

Objective To investigate the monitoring of renal microcirculation perfusion alteration with contrast-enhanced ultrasound （CEU） during cardiopulmonary bypass （CPB）. Methods Renal microcirculation perfusion before and during CPB was assessed by CEU. Time-intensity curve （TIC） were derived from three region of interest （ROD using QLAB post-analysis software. Parameters such as TIC curve wash in slope （A）, area under curve （AUC）, peak intensity （DPI） as well as time to peak intensity （TTP） were then calculated. Results Contrast-enhanced ultrasound showed a significant reduction （or elongation） of perfusion parameter （A, AUC, DPI,TTP） in all three regions （superficial cortex, deep cortex and medulla） during cardiopulmonary bypass in comparison with normal cardiac cycle. Conclusion Cardiopulmonary bypass （CPB） has a dramatic impact on renal microcirculation in pediatric patients which manifest as global reduction in renal perfusion as well as significant region perfusion difference. Contrast-enhanced ultrasound （CEU） could detect the renal microcirculation alteration during CPB.