超声评估Stanford A型主动脉夹层术前后不同受累分型的肾血流灌注变化

Ultrasound Evaluation of Changes in Renal Blood Perfusion of Different Types of Involvement Before and After Stanford A Aortic Dissection

目的通过超声动态观察Stanford A型主动脉夹层不同受累分型的肾内血流动力学参数及肾血流灌注变化。资料与方法前瞻性纳入北京安贞医院2016年1—12月接受Sun’s手术治疗的Stanford A型主动脉夹层患者40例共80个肾脏,分别于术前1 d、术后24 h、术后48 h测量双肾叶间动脉收缩期峰值流速(PSV)、舒张期最小流速(EDV)、平均流速(Vm)、搏动指数(PI)、阻力指数(RI),以CT血管成像(CTA)结果将肾脏灌注来源分为真腔型、假腔型、肾动脉受夹层累及型,比较术前1 d、术后24 h、术后48 h每个时间不同分型肾脏血流动力学参数的差异,以及同一分型肾脏在不同时间血流动力学参数的差异,并将不同肾动脉受累分型与超声彩色多普勒半定量评级进行分析。结果80个肾脏中,真腔型54个,假腔型21个,双腔或肾动脉受累型5个。真腔型肾的Vm、PI、RI在3个时间点差异均有统计学意义(F=3.083、3.630、7.050,P均<0.05)。术前1 d不同分型肾叶间动脉RI差异有统计学意义(F=3.222,P<0.05),其余时间点各血流动力学参数差异无统计学意义(P>0.05)。术后48 h不同分型肾血流灌注半定量评级差异有统计学意义(F=0.442,P<0.05)。假腔型肾血流灌注半定量0~2级的比例为66.7%(14/21),真腔型肾血流灌注半定量0~2级的比例为31.5%(17/54),真腔型术后肾血流灌注半定量主要为3级血流,而假腔型和肾动脉受夹层累及型术后肾血流灌注半定量主要为2级血流。结论超声对于Stanford A型主动脉夹层肾动脉不同受累分型的血流动力学参数中,Vm、PI、RI对临床具有很好的参考价值。术后肾脏血流灌注半定量评级对肾损伤状态具有直观的指导意义。

Purpose To dynamically observe the intrarenal hemodynamic parameters and renal blood perfusion changes of Stanford A aortic dissection with different types of involvement by ultrasound.Materials and Methods Forty patients with Stanford type A aortic dissection who underwent Sun’s surgery in Beijing Anzhen Hospital from January to December 2016 were enrolled,with a total of 80kidneys.The peak-systolic velocity(PSV),end diastolic velocity(EDV),mean-velocity(Vm),pulsative-index(PI)and resistive-index(RI)of the interlobular arteries of the kidneys were measured 1 day before operation,24 hours after operation and 48 hours after operation.According to CT angiography(CTA)results,the source of renal perfusion was classified into true cavity type(T),false lumen type(F)and renal artery involvement(B),compared the hemodynamic parameters of different types of kidneys at each time point before,24 hours after surgery and 48hours after surgery,and also compared the differences in the hemodynamic parameters of the same type of kidney.The hemodynamic parameters at different time points were different,different renal artery involvement types and ultrasound color Doppler semi-quantitative ratings were statistically analyzed.Results Among 80 kidneys,there were 54 cases of type T kidneys,21 cases of type F kidneys,and 5 cases of type B kidneys.Vm,PI and RI of type T kidney were statistically different at three time points(F=3.083,3.630,7.050,P<0.05).The preoperative RI of different types of interlobular renal arteries had statistically significant differences(F=3.222,P<0.05),and the differences in hemodynamic parameters at other time points were not statistically significant(P>0.05).There was a statistically significant difference in the semi-quantitative rating of renal blood perfusion of different types at 48 hours after operation(F=0.442,P<0.05).The proportion of F type renal blood perfusion semi-quantitative 0-2 grade was 66.7%(14/21),the proportion of T type renal blood perfusion semi-quantitative 0-2grade was 31.5%(17/54),and the semi-quantitative renal blood perfusion after T type was mainly grade 3 blood flow,while the semiquantitative renal blood perfusion after F and B type was mainly grade 2 blood flow.Conclusion Among the hemodynamic parameters of different types of Stanford A-type aortic dissection renal artery involvement,Vm,PI and RI have good clinical reference value for ultrasound.The semi-quantitative rating of renal blood perfusion after operation has intuitive guiding significance for the state of renal injury.