肾脏灌注压多少合适?  

Renal perfusion pressure:what is appropriate?

作　　者：胡成欢 张丽娜[1,2,3] Hu Chenghuan;Zhang Lina(Department of Critical Care Medicine,Xiangya Hospital Central South University,Changsha 410008,China;Chinese Critical Ultrasound Study Group)

机构地区：[1]中南大学湘雅医院重症医学科,湖南长沙410008 [2]中国重症超声研究组 [3]中华医学会重症医学分会

出　　处：《临床荟萃》2019年第7期590-594,共5页Clinical Focus

基　　金：湖南省卫生计生委科研基金课题——脑血管自动调节功能评估在脓毒症相关性脑病诊治中的应用研究(B2016110);吴阶平基金会项目——重症休克患者液体治疗现状调查:一项多中心,前瞻性,观察性研究(HRJJ20171038)

摘　　要：肾脏是机体供血量最丰富的器官,具有较强的血流自主调节能力,使得动脉压在一定范围内发生变化时肾血流量具有保持相对稳定的能力。多种因素如炎症反应、脓毒症、容量不足、梗阻、缺血-再灌注损伤和手术等均可以导致肾血流自主调节功能受损,此时动脉血压的较小波动就可能引起肾小球滤过率的明显波动,导致急性肾功能损伤。因此,对肾脏灌注水平的监测显得尤为重要。临床上可通过彩色多普勒、肾动脉血流频谱、肾脏增强超声造影等肾脏超声技术、近红外光谱技术、磁共振成像组织氧监测等监测肾脏灌注。由于潜在疾病和基础疾病状态不同,对于确保足够的肾灌注压而言,每个患者的最佳血压值并不一样。临床实践过程中强调越低越好的中心静脉压和肾血流灌注为导向的滴定式和个体化治疗策略来调节机体容量状态和肾脏灌注压水平。Kidney is the organ with the most abundant blood supply. It has a strong ability of self-regulation of blood flow,which makes the blood flow of kidney relatively stable when the arterial pressure changes in a certain range.Various causes,which range from inflammation,sepsis,insufficient capacity, obstruction to ischemia-reperfusion injury and surgery,can lead to impaired autonomic regulation of renal blood flow. At this time,small fluctuation of arterial blood pressure may lead to obvious fluctuation of glomerular filtration rate,contributing to acute renal function damage.Therefore,the monitoring of renal perfusion is of significant importance.Renal perfusion can be monitored by renal ultrasound such as color Doppler,renal blood flow spectrum, contrast-enhanced ultrasound,and tissue oxygen monitoring such as near infrared spectroscopy,magnetic resonance imaging tissue oxygen monitoring in clinic.Due to various potential diseases and basic disease status,the optimal blood pressure for each patient is different to ensure adequate renal perfusion pressure.Clinical practice prefers lower central venous pressure, and the titration and individualized therapy strategies guided by renal blood flow perfusion to regulate body volume status and renal perfusion pressure.

关 键 词：急性肾损伤 血液灌注 肾循环 超声检查 血管阻力 

分 类 号：R322.61[医药卫生—人体解剖和组织胚胎学]