重症急性胰腺炎导致急性肾损伤的可视化监测

Visual monitoring of acute renal injury secondary to severe acute pancreatitis

急性肾损伤(Acute renal injury,AKI)是急性胰腺炎(Acute pancreatitis,AP)转为重症急性胰腺炎(Severe acute pancreatitis,SAP)的常见并发症,治疗重在早发现。AKI的早期诊断方法仍存在争议,通过识别肾脏灌注或微循环失衡的可视化方法,逐渐得到多样化研究。MRI、增强CT、超声造影均可获得相对稳定的肾灌注影像,有利于图像分析预警AKI;AP早期常规腹部增强CT可增加肾脏图像分析,可能有利于预警AKI,但不适于重症患者AKI的动态监测,且造影剂对肾功能也有损害;MRI虽可避免使用造影剂,但受限于检查本身对患者要求较高,也不便于对重症患者动态监测。对于重症患者,床旁超声检查更易获得,而且超声微泡造影剂无肾损伤。肾超声造影可动态反映肾灌注及微循环,图像分析可预测肾损伤的发生。随着重症超声设备的普及和技术的发展,在SAP继发AKI的动态监测上,超声有着令人期待的应用前景。

Acute kidney injury(AKI)is a common complication of acute pancreatitis(AP)turning into severe acute pancreatitis(SAP).The key treatment is early detection.The early diagnosis of AKI is still controversial,and it has been gradually studied by the visualization method to identify renal perfusion or microcirculation imbalance.MRI,enhanced CT and contrast-enhanced ultrasound can obtain relatively stable renal perfusion images,which are conducive to image analysis and early warning of AKI;In the early stage of acute pancreatitis,conventional abdominal enhanced CT can increase the renal image analysis,which may be helpful for early warning of AKI,but it is not suitable for the dynamic monitoring of AKI in severe patients,and the contrast medium can also damage the renal function.Although MRI can avoid the use of contrast media,it is not convenient for dynamic monitoring of critically ill patients due to its high requirements on patients.For critical patients,bedside ultrasound is easier to obtain,and ultrasound microbubble contrast agent does not produce renal injury.Contrast enhanced renal ultrasound can dynamically reflect renal perfusion and microcirculation,and image analysis can predict the occurrence of renal injury.With the popularization of severe ultrasound equipment and the development of technology,ultrasound has a promising application prospect in the dynamic monitoring of AKI secondary to SAP.