超声造影评估结石梗阻性肾病患者围手术期肾脏血流动力学的研究

Contrast-enhanced ultrasound assessment of perioperative renal hemodynamic changes in patients with calculi obstructive nephropathy

目的探讨超声造影评估梗阻性肾病患者手术前后肾脏血流动力学的变化。方法 60例因结石引起的梗阻性肾病患者术前及术后1和2个月行超声造影检查,采用随机QLAB分析软件获取肾脏超声造影血流灌注时间-强度曲线(TIC)及相关参数[曲线下面积(AUC)、曲线上升支斜率(A)、峰值强度(PI)、达峰时间(TTP)、曲线下斜率(α)],并检测肾小球滤过率(GFR)。结果手术前后随着GFR增加,AUC减小,TTP缩短,A减小,PI升高。结论肾脏实时超声造影定量分析技术可实时观察肾皮质血流灌注过程,显示肾脏血流灌注与GFR水平有良好的相关性,其监测结石引起的梗阻性肾病患者术后肾脏血流动力学变化有较高的临床应用价值。

[Objective] To explore contrast-enhanced ultrasound evaluation of preoperative and postoperative renal hemodynamic changes in obstructive nephropathy patients. [Methods] Contrast-enhanced ultrasound examination was applied to 60 cases with calculi obstructive nephropathy preoperatively and 1 and 2 months after operation. Random QLAB analysis software was used for analyses of renal ultrasound imaging perfusion time intensity curve （TIC） and related parameters [area under curve （AUC）, the curve slope （A）, peak intensity （PI）, time to peak （TIP） and curve slope （alpha）], and glomerular filtration rate （GFR） was detected. [Results] Before and after operation, with glomerular filtration rate （GFR） increasing, AUC decreased, TIP shortened, the curve slope （A） decreased, and peak intensity （PI） increased. [Conclusions] Kidney real-time contrastenhanced ultrasound quantitative analysis technology can provide real-time observation of renal cortex perfusion, well reflect the correlation between the real level of renal perfusion and glomerular filtration rate （GFR） level. It has a high clinical application value in monitoring postoperative renal hemodynamics in patients with obstructive nephropathy caused by kidney stone.