肾阻力指数对剖宫产术后妊娠期高血压相关性急性肾损伤可逆性诊断的预测价值  

Diagnostic accuracy of Doppler renal resistive index for reversibility of AKI in gestational hypertension after operation

作　　者：石秀霞[1] 马胜辉[1] 李立[1] 施保柱 姬云飞[1] 

机构地区：[1]承德市中心医院重症医学科,河北承德067000

出　　处：《临床和实验医学杂志》2017年第7期648-650,共3页Journal of Clinical and Experimental Medicine

基　　金：河北省承德市科学技术研究与发展计划项目(编号:20151014)

摘　　要：目的观察使用肾脏超声实时监测肾动脉阻力指数(RRI)变化能否准确预测急性肾损伤(AKI)的可逆性。方法选取妊娠期高血压相关42例AKI患者为研究对象(持久性AKI 13例和临时性AKI 29例),未合并AKI的妊娠期高血压患者10例为对照组。在术毕返回ICU(T1)时间点、术后3d(T2)进行肾脏超声检查取得肾叶间动脉或肾弓形动脉多普勒频谱参数,测量并记录RRI值。在相应时间点采集动脉血进行血清肌酐(Scr)检测。根据术后3d AKI的转归情况将所有入组病例分为暂时性AKI组和持久性AKI组,并进行统计学对比分析。结果 T1时间点RRI值,持久性AKI组显著高于无AKI组和暂时性AKI组,三组之间有显著差异(P<0.05);T2时间点RRI值,持久性AKI组显著高于无AKI组和暂时性AKI组,三组之间有显著差异(P<0.05);T1与T2的RRI值变化趋势比较,无AKI组无明显变化,暂时性AKI组恢复趋势明显好于持久性AKI组(P<0.05)。T1点RRI值ROC曲线判断持久性AKI,AUC为0.944,RRI值界值0.78,预测持久性AKI敏感度0.923,特异度0.950。结论肾阻力指数可以作为预测妊娠期高血压相关急性肾损伤逆转的有效工具,为临床采取干预措施提供帮助。Objective To observe of the use of renal ultrasound real-time monitoring of renal artery resistance index（RRI）,and to observe whether the changes can accurately predict the reversibility of acute kidney injury. Methods A total of 42 patients with AKI were selected as the control group（10 patients with persistent AKI and 29 patients with temporary AKI）. 10 patients with gestational hypertension without AKI were treated with control group. The data of doppler-based RRI were recorded and the blood samples were collected from peripheral arterial after operation（T1） and the third day postoperative（T2）. We assessed the performance of the Doppler RRI in each patient. At the same time,renal function and prognosis were observed and recorded. The subjects in our own ICU were divided into three groups： no AKI、transient AKI and persistent AKI. The effect of the renal function in women with renal perfusion was analyzed by using statistical analysis,and the changes of renal arterial resistance index were evaluated by using the bedside renal ultrasound in real-time. Results The RRI and T2 I in the AKI group were significantly higher than those in the AKI group（P〈0.05）,and there was no significant difference between the two groups（P〈0.05）. There was no significant change in the RRI values between T1 and T2,but there was no significant change in the AKI group and the recovery rate of the AKI group was significantly better than that of the persistent AKI group（P〈0.05）. T1 RRI ROC curve to determine the persistence of AKI,AUC of 0.944,RRI value of 0.78,the prediction of persistent AKI sensitivity of 0.923,specificity 0.950. Conclusion RRI can be used as an effective tool for predicting the reversal of acute renal impairment associated with hypertension in pregnancy for clinical interventions.

关 键 词：急性肾损伤 妊娠期高血压 肾脏超声 血肌酐 

分 类 号：R719.8[医药卫生—妇产科学]