彩色多普勒超声在急性百草枯中毒心肾损伤程度判断中的应用价值

Application value of color Doppler ultrasound in judgment of cardiac and renal injury during acute paraquat poisoning

目的探讨彩色多普勒超声在急性百草枯中毒病情判定中应用的临床意义。方法回顾性调查了我院收治的114例各型百草枯中毒的临床资料,尤其是重点分析了肾脏血流灌注、肾动脉阻力指数(RI)以及左心室收缩功能指标EF、FS、CO、SV、左室壁运动情况及其在治疗过程中的变化特点。结果 114例患者中,轻型中毒55例、中-重型中毒31例、暴发型中毒28例,共死亡36例,平均死亡率为31.6%。彩色多普勒超声检查显示:轻型中毒患者肾脏血流灌注以充满型或边缘缺损型为主,RI 0.61±0.02,左心室收缩功能指标EF(55.2±3.9)%,FS(24.8±4.2)%,左室壁运动大部分正常,仅有2例左室壁搏动轻度减弱;中-重型中毒患者肾脏血流灌注以星点型为主,少数呈边缘缺损型或无血流型,RI 0.67±0.04,EF(42.2±4.6)%,FS(21.8±3.0)%,14例左室壁运动正常,17例左室壁搏动伴不同程度减弱;暴发型中毒患者肾脏血流灌注大部分呈无血流型或星点型为主,仅1例呈边缘缺损型,RI 0.74±0.05,EF(25.2±4.3)%,FS(18.9±3.8)%,全部病例左室壁运动有不同程度减弱。轻型与中-重型、暴发型测量指标RI、EF、FS的差异有统计学意义。结论肾脏内部血流灌注情况及肾动脉RI均可反映肾功能受损害的程度,M型超声心动图通过测量左心室收缩功能指标EF、FS可提示心肌收缩功能是否受累及;肾脏血流灌注无血流型或星点型、RI>0.70、EF<30%、FS<14%提示预后差,且死亡率高,表明彩色多普勒超声在急性百草枯中毒心肾损伤程度的判断有重要临床价值。

Objective To investigate the clinical significance of color Doppler ultrasonography in the judgment of cardiac and renal damage during acute paraquat. Methods A retrospective survey of the clinical data of 114 acute paraquat poisoning cases in our hospital was made in the study, especially focused the ultrasound examination results on the hearts and kidneys, such as renal perfusion, renal artery resistance index（ RI）, left ventricular systolic function indexes （EF, FS changes, CO, SV） and left ventricular wall motion indices during treatment. Results In 114 patients, 55 cases were mild poisoning, 31 cases were middle or severe poisoning, 28 cases were fulminant poisoning, 36 cases died, the average mortality was 31.6%. Additionally, the color Doppler ultrasound examination showed as well that in mild poisoning patients the renal perfusion mainly were full type or edge defect type, RI was 0.61 ±0.02, left ventricular systolic funcation indexes such as EF was （55.2 ± 3.9） %, FS （24. 8 ± 4. 2） %, only 2 cases showed left ventricular wall pulsation mildly impaired; in middle or severe poisoning cases the renal perfusion was star-point type, a few were edge defect type or no flow type, RI was 0. 67 ± 0. 04, EF was （42. 2 ＋4. 6）%, FS （21.8 ＋3.0）%, 17 cases in 31 patients showed left ventricular wall pulsation decreased; while in fulminant poisoning cases, majority were no flow type or star-point type, only 1 cases showed the edge defect, the RI was 0. 74 ± 0. 05, EF was （25.2 ± 4. 3） %, FS （ 18.9 ± 3.8） %, near all these cases the left ventricular wall motion showed some weakened, and there were statistical differences in the indices such as RI, EF, FS among mild, middle or severe, and fulminant cases. Conclusion The results showed that the renal internal perfusion status and renal arterial resistance（RI） can reflect renal damage degree, M type ultrasound echocardiogram may reflect cardiac contractile function by measuring left ventricular systolic indexes such as EF, FS; while poor renal blood perfusion, such as no flow type or star-point type, RI 〉 0. 70, EF 〈 30%, FS 〈 14% were the signals of bad prognosis. All the results mentioned above suggested that color Doppler ultrasound has important value in the judgment of cardiac and renal injury during acute paraquat poisoning.