超声测定肾阻力指数对严重创伤后急性肾损伤的评估价值  

Doppler-based renal resistive index for the assessment of acute kidney injury in major trauma patients

作　　者：朱建刚[1] 高玉芝[2] 叶立刚[2] 刘志海[2] 张茂[2] 

机构地区：[1]嘉兴市第一医院重症医学科,浙江嘉兴314000 [2]浙江大学医学院附属第二医院急诊医学科 浙江大学急救医学研究所,浙江杭州310009

出　　处：《中国急救医学》2016年第8期730-735,I0002,共7页Chinese Journal of Critical Care Medicine

基　　金：国家十二五“科技支撑计划项目”创伤和重症急救技术研究（2012BAI11B00）;浙江省重症医学科技创新团队（2011R50018）

摘　　要：目的探讨超声测定肾阻力指数对严重创伤后急性肾损伤（acute kidney injury，AKI）的评估价值。方法前瞻性观察浙江大学医学院附属第二医院2013—12～2014—02急诊监护室（EICU）收住的44例严重创伤患者，应用多普勒超声连续7d测定肾脏叶间动脉阻力指数（RRI），同时记录血管活性药物使用情况、心率、脉压、平均动脉压、ICU住院时间、机械通气时间。根据7d内是否发生AKI分为AKI组和非AKI组，比较两组患者RRI的动态变化。以不同时点RRI作为诊断评价试验，描记受试者工作特征（receiver operating characteristic，ROC）曲线，比较不同时点的曲线下面积。以RRI为因变量进行逐步线性回归分析，筛选出与RRI显著相关的指标。结果44例患者中男性35例，女性9例，年龄（53±14）岁，APACHEⅡ评分（13．3±8.3）分，ISS评分（31．3±8．2）分。AKI组8例，非AKI组36例，两组患者血管活性药物使用比例、APACHEⅡ评分、28d病死率比较差异有统计学意义（P〈0．05）。入ICU后连续7dAKI组的RRI值高于非AKI组，1～7dRRI诊断AKI的曲线下面积分别为0．731±0．134、0．773±0．121、0．843±0．075、0．808±0．118、0．769±0．114、0．840±0．121、0．811±0．118（均P〈0．05），各时点间的曲线下面积比较差异均无统计学意义（均P〉0．05）。逐步线性回归分析发现，第1～7天年龄、AKI分期与RRI呈显著正相关。结论超声动态测定肾阻力指数变化与创伤后AKI有关，并在一定程度上反映AKI的严重程度，可作为传统肾功能评价方法的有益补充。Objective The objective of this study was to test Doppler-based renal resistive index （RRI） for the assessment of acute kidney injury in major trauma patients. Methods This was a prospective observational study in emergency intensive care unit （EICU） in a teaching university hospital. From Deeember 2013 to February 2014, a total of 44 major trauma patients were enrolled. Measurements of hemodynamic parameters and Doppler-based RRI were obtained at the first 7 days from admission to the EICU. Injury severity score （ISS）, Acute Physiology and Chronic Health Evaluation system （APACHE） Ⅱ, Glasgow coma score （GCS）, ICU length of stay, the duration of ventilator support were recorded. All patients were divided into AKI group and no-AKI group. The above indicators were statistically compared between the two groups. We drew the receiver operating characteristic （ROC） curves of RRI to judge AKI and determined the best critical points of RRI to judge AKI at the first 7 days from admission to the EICU, then compared their areas under the curves by z test. The indices correlated significantly with RRI were filtrated by stepwise linear regression analysis. Results Among 44 patients, there were 8 patients in AKI group and 36 patients in no-AKI group. Patients in AKI group had higher RRI than those in no-AKI group. The areas under the ROC curves of RRI to judge AKI were 0.731±0.134, 0.773±0.121,0.843 ±0.075,0.808±0.118,0.769±0.114,0.840±0.121,0.811±0.118 separately at the first 7 days from admission to the EICU, and they were all more than 0.5 significantly. There were no significant differences among them. Age and AKI stage correlated signifieantly with RRI at the first 7 days from admission to the EICU. Mean arterial pressure, hear rate, arterial partial pressure of oxygen and pulse pressure correlated signifieantly with RRI at some days. Conclusion Doppler-based RRI correlated significantly with AKI in major trauma patients, and reflected AKI severity to some extend. Dopplerbased RRI ean be u

关 键 词：严重创伤 肾阻力指数(RRI) 急性肾损伤(AKI) 多普勒 超声 

分 类 号：R726.992[医药卫生—儿科]