重症患者溶液冲击治疗后肾脏抵抗指数的变化  

The renal perfusion assessment by renal Doppler during fluid challenge in critical patients

作　　者：邓超[1] 李英[1] 苏醒[1] 曹玉芳[1] 陈栩栩[1] 

机构地区：[1]海口市人民医院重症医学科,570208

出　　处：《中华临床医师杂志（电子版）》2013年第22期83-87,共5页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：目的初步探讨溶液冲击治疗后肾脏抵抗指数的变化。方法前瞻性队列研究,纳入35例需要连续机械通气和大量输液治疗的ICU患者,大量输液治疗前后给予肾脏抵抗指数检测。肾脏多普勒检测肾脏抵抗指数,食管多普勒监测主动脉血流。结果 35例ICU患者中,17例(49%)患者符合溶液冲击反应的条件,主动脉血流量至少增加10%。液体冲击后,平均动脉压力从73 mm Hg(四分位距68～79?mm Hg)上升到80 mm Hg(四分位距75～86?mm Hg)具有统计学差异(P<0.0001),心脏每搏量从50 ml(四分位距30～77?ml)增加到55 ml(39～84?ml),具有统计学差异(P<0.0001)。液体冲击后溶液冲击应答组中心脏每搏量改变了+28.6%(+18.8%～+38.8%),液体冲击非应答组的每搏量是+3.1%(-1.6%～+7.4%)。肾脏抵抗指数在溶液冲击治疗无应答前为0.72(0.67～0.75)和后0.71为0.67～0.75),未发生改变(P=0.62)。肾脏抵抗指数在溶液冲击应答前0.70为(0.65～0.75)和后为0.72(0.68～0.74),也未改变(P=0.11)。心脏每搏量与溶液冲击后抵抗指数之间无明显相关性(r2=0.04,P=0.25),包括溶液冲击应答者(r2=-0.02,P=0.61)和溶液冲击无应答者(r2=0.08,P=0.27)。心脏每搏量与亚组溶液冲击后抵抗指数改变是否伴有急性肾损伤无相关性。结论溶液冲击后全身血流动力学改变没有引起肾脏抵抗指数变化,与是否伴随急性肾损伤无相关性。Objective To assess renal resistive index variations in response to fluid challenge. Methods This is prospective cohort study, 30 patients with consecutive patients receiving mechanical ventilation and requiring a fluid challenge, which was measured resistive index before and after fluid challenge. Renal Doppler was used to measure resistive index and esophageal Doppler to monitor aortic blood flow. Results Of the 35 included patients, 17 （49%） met our definition for fluid challenge responsiveness, that is, had at least a 10% increase in aortic blood flow. After fluid challenge, mean arterial pressure increased from 73 mm Hg （interquartile range 68-79） to 80 mm Hg （75-86; P〈0.0001） and stroke volume from 50 ml （30-77） to 55 ml （39-84; P〈0.0001）. Stroke volume changes after fluid challenge were ＋28.6% （＋18.8% to＋38.8%） in fluid challenge responders and ＋3.1%（-1.6%to 7.4%） in fluid challenge nonresponders. Renal resistive index was unchanged after fluid challenge in both nonresponders （0.72 [0.67-0.75] before and 0.71 [0.67-0.75] after fluid challenge;P=0.62） and responders （0.70 [0.65-0.75] before and 0.72 [0.68-0.74] after fluid challenge;P=0.11）. Stroke volume showed no correlations with resistive index changes after fluid challenge in the overall population （r2=0.04, P=0.25）, in fluid challenge responders （r2=-0.02, P=0.61）, or in fluid challenge nonresponders （r2=0.08, P=0.27）. Stroke volume did not correlate with resistive index changes after fluid challenge in the subgroups without acute kidney injury （AKIN definition）, with transient acute kidney injury, or with persistent acute kidney injury. Conclusion Systemic hemodynamic changes induced by fluid challenge do not translate into resistive index variations in patients without acute kidney injury, with transient acute kidney injury, or with persistent acute kidney injury.

关 键 词：危重病 超声检查 多普勒 急性肾损伤 液体冲击 肾脏抵抗指数 

分 类 号：R692.9[医药卫生—泌尿科学]