肾阻力指数对术后脓毒症休克患者发生持续性急性肾损伤的预测价值  

Value of Renal Resistive Index To Predict Persistent Acute Kidney Injury in Postoperative Patients with Septic Shock

作　　者：付优[1] 葛晨 何聪[1] 白银箱 张娜[1] 赵鹤龄[1] Fu You;Ge Chen;He Cong;Bai Yinxiang;Zhang Na;Zhao Heling(Department of Intensive Care Unit,Hebei General Hospital,Shijiazhuang,Hebei 050051,China)

机构地区：[1]河北省人民医院重症医学科,石家庄市050051

出　　处：《中国超声医学杂志》2021年第5期555-559,共5页Chinese Journal of Ultrasound in Medicine

摘　　要：目的评估肾阻力指数对术后脓毒症休克患者发生持续性急性肾损伤(AKI)的预测价值。方法选取外科手术后脓毒症休克患者50例,行床旁超声测定入选患者的肾阻力指数(RRI)。根据是否发生持续性AKI分为非持续性AKI组和持续性AKI组,比较两组间的基础情况及可能与持续性AKI有关的指标,采用Logistic回归分析影响术后脓毒症休克患者持续性AKI危险因素。描记受试者工作特征(ROC)曲线评价RRI对术后脓毒症休克患者发生持续性AKI的预测价值。结果持续性AKI组的年龄、APACHEⅡ评分、SOFA评分、血肌酐、RRI较非持续性AKI组高,差异有统计学意义(P<0.05)。SOFA评分、RRI为术后脓毒症休克患者持续性AKI危险因素。肾阻力指数≥0.695预测术后脓毒症休克患者持续性AKI的ROC曲线下面积为0.741,预测价值不高。联合RRI和SOFA评分预测价值大于其中任何一个指标,其ROC曲线下面积为0.893(95%CI,0.615~0.809)。结论肾阻力指数对术后脓毒症休克患者发生持续性AKI的预测价值不高,联合SOFA评分的预测能力大于单一指标,为临床早期预防及干预提供线索。Objective To explore the value of renal resistive index(RRI) to predict persistent acute kidney injury(AKI) in postoperative patients with septic shock. Methods 50 postoperative patients with septic shock were enrolled and bedside Doppler-based RRI of these patients was obtained at the first day. The patients were divided into non-persistent AKI and persistent AKI groups according to the presence of persistent AKI.A comparison of baseline characteristic and some risk factors related to persistent AKI between the two groups was made.The variables independently affecting persistent AKI in postoperative patients with septic shock were identified by logistic regression analysis.The predictive value of RRI for persistent AKI were analyzed by the area under receiver operating characteristic curve(AUROC). Results Patients in persistent AKI group had significantly higher age, APACHE Ⅱ score, SOFA score, serum creatinine and RRI(P<0.05).RRI and SOFA score were independent risk factors for persistent AKI in postoperative patients with septic shock by multiple logistic regression.An RRI≥0.695 had a 78% sensitivity and 59% specificity for persistent AKI and it performed poorly with an AUROC value of 0.741.However, the AUROC value of the combination of RRI and SOFA score was 0.893(95%CI,0.615-0.809),which was greater compared with either RRI or SOFA score alone. Conclusions The RRI performs poorly in predicting persistent AKI in postoperative patients with septic shock.The combination of RRI and SOFA score may be a better indicator, which can provide clues to prevention and treatment.

关 键 词：外科手术后 脓毒症休克 肾阻力指数 急性肾损伤 

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] R692[医药卫生—临床医学]