超声在脓毒症合并急性肾损伤患者诊断及预后评估中的价值

Value of ultrasound evaluation in the diagnosis and prognosis of acute kidney injury

目的 本研究旨在通过比较超声技术测定肾动脉阻力指数（resistive index, RI）和能量多普勒超声（power Doppler ultrasound, PDU）半定量评分方法,探讨肾脏超声对脓毒症合并急性肾损伤（AKI）患者的诊断及预后评估价值.方法 将入选的脓毒症患者按KDIGO标准分为四组：脓毒症组、AKI 1期组、AKI 2期组和AKI 3期组（每组各10例）.入组6 h内记录每组患者一般情况及相关实验室检查,同时肾脏超声测量右侧肾脏的叶间动脉RI值,采用PDU显像4级法行半定量评分.比较不同组别间患者一般情况,AKI分期与RI、PDU评分的相关性,以及与患者预后相关的因素.结果 各组PDU评分比较差异有统计学意义,并且与血肌酐（SCr）水平、肾脏替代治疗（CRRT）天数呈显著负相关.AKI 3期组RI与其他三组比较差异有统计学意义（P〈0.05）,并且与SCr水平显著呈正相关.PDU评分与RI呈显著负相关.APACHEⅡ评分、心率、SCr对患者死亡情况有显著的正向影响.结论 与RI比较,PDU评分更能反映AKI严重程度分期,但是两者均不能预测患者预后.

Objective The aim of this study was to evaluate the relationship between renal resistive index（RI）and power Doppler ultrasound（PDU）.The effectiveness of each method to predict acute kidney injury（AKI）also was compared.Methods Forty enrolled patients were divided into three groups by KDIGO guideline： sepsis group, AKI 1 group, AKI 2 group and AKI 3 group, with 10 patients in each group.Renal RI and 4-level semiquantitative PDU score were recorded;AKI stage and RI/PDU were compared;the co-variables of death were also analyzed.Results There were statistical differences for PDU score in the AKI 1 group, AKI 2 group and AKI 3 group, and RI of AKI 3 group was higher than that in the other three groups.Furthermore, PDU score was significantly correlated with SCr level and CRRT treatment days.APACHEⅡ score, heart rate and SCr were closely correlated with death.Conclusion Compared with RI, PDU score maybe better to monitor the severity of AKI, but both have no correlation with the prognosis of AKI.