超声监测体外膜肺氧合支持治疗中的肾脏血流  

Ultrasound monitoring the renal blood flow during extracorporeal membrane oxygenation

作　　者：刘晓真[1] 李建伟[2] 刘少中[1] 李斌飞[3] 叶木奇[1] 周广新[1] 郑智文[1] 黄泳航[1] 文鼎华[1] 杨坤[1] Liu Xiaozhen Li Jianwei Liu Shaozhong Li Binfei Ye Muqi Zhou Guangxin Zheng Zhiwen Huang Yong-hang Wen Dinghua Yang Kun(Department of Uhrasonography, Zhongshan People＇s Hospital, Zhongshan 528403, Chin Department of lntensive Care Unit, Zhongshan People＇s Hospital, Zhongshan 528403, China Department of Anesthesiology, Zhongshan People＇s Hospital, Zhongshan 528403, China)

机构地区：[1]中山市人民医院超声影像科,广东省中山528403 [2]中山市人民医院重症监护室,广东省中山528403 [3]中山市人民医院麻醉科,广东省中山528403

出　　处：《中国医师杂志》2017年第6期824-826,832,共4页Journal of Chinese Physician

摘　　要：目的探讨超声在体外膜肺氧合（ECMO）支持治疗中对肾脏血流情况的监测应用。方法应用彩色多普勒超声显像仪，对21例因心功能衰竭（心脏术后15例，急性心肌炎6例）接受静脉一动脉ECMO治疗且合并肾功能损害，同时未接受连续性肾脏代替疗法的患者，在建立ECMO前、建立ECMO后即刻、建立ECMO后每日以及ECMO停机后即刻进行床旁肾脏超声检查，测量肾大叶间动脉峰值流速，并计算肾大叶间动脉血流阻力指数，同时记录患者血肌酐、血尿素氮，并将各次所得数据进行比较。结果与ECMO后即刻比较，ECMO后2d及撤离ECMO后即刻的肾大叶问动脉峰值流速逐渐增高（P〈0．05），肾大叶间动脉血流阻力指数、血肌酐、血尿素氮逐渐减低，差异均有统计学意义（P〈0．05）。结论在体外膜肺氧合支持治疗中，应用超声能有效监测肾脏的血流学情况，及时为临床医生提供重要参数并作为诊疗的依据。Objective To investigate the utilization of ultrasound monitoring the renal blood flow during extracorporeal membrane oxygenation （ECMO）. Methods Twentry one eases , who received veinartery ECMO for heart failure, were examinated by bed-side ultrasound before the ECMO initiated, right after the ECMO initiated, each day after the ECMO initiated, and right after the ECMO weaned. The renal in- terlobar artery peak velocity （ Vmax ） was measured, and the renal interlobar artery resistant index （ RI ） was calculated, as well as the values of the serum creatinine （SCr） and blood urea nitrogen （BUN） were recorded. All the data were compared. Results Compared to the variables right after the ECMO initiated, the Vmax increased （P 〈 0. 05） two days after ECMO initiated and right after the ECMO weaned, while RI （ P 〈 0. 05 ）, SCr （ P 〈 0. 05 ） and BUN （ P 〈 0. 05 ） decreased, there being significant differences （ P 〈0. 05 ）. Conclusions While treating patients with extracorporeal membrane oxygenation, the ultrasound can monitoring the renal blood flow effectively, and provide important parameters for the clinical doctors as the basis of the diagnosis and treatment.

关 键 词：超声检查 体外膜氧合作用 肾循环 

分 类 号：R445.1[医药卫生—影像医学与核医学] R459.7[医药卫生—诊断学]