床旁超声评估肾血流灌注在急性肾损伤患者CRRT撤机中的应用价值  

作　　者：王生超 彭伟[1] 陈琨[1] 

机构地区：[1]浙江省金华市中心医院,321000

出　　处：《浙江临床医学》2023年第8期1205-1207,共3页Zhejiang Clinical Medical Journal

基　　金：浙江省科技厅省级重点研发计划项目(2020C03019)。

摘　　要：目的探讨床旁超声评估肾血流灌注对急性肾损伤患者连续性肾脏替代治疗(CRRT)撤机的应用价值。方法收集45例在本院ICU因急性肾损伤(AKI)需要CRRT治疗的患者作为观察对象,均行CRRT撤机试验,撤机后1周不需要继续CRRT的视为成功,否则视为失败。成功撤机的患者设为A组(27例),撤机失败的患者设为B组(18例)。在撤机试验前,采用超微血流成像(SMI)与彩色多普勒(CDFI)评价患者肾脏血流灌注情况,并采用自定义评分标准对其进行血流灌注评分。记录患者撤机试验前血肌酐(CRE)水平及24 h的尿量,并对两组数据进行分析。结果A组患者CDFI评分值与SMI评分值均明显高于B组,差异有统计学意义(P<0.05);A组患者SMI评分值明显高于CDFI评分值,差异有统计学意义(P<0.05)。两组患者CRE及尿量无明显差异(P>0.05)。将患者撤机前CDFI、SMI评分值纳入CRRT撤机试验成功与否判断的ROC曲线分析中,CDFI、SMI的曲线下方面积(AUC)分别为0.681、0.798,其中SMI的敏感度和特异度均高于CDFI,差异具有统计学意义(P<0.05)。结论床旁超声评估肾血流灌注对AKI患者CRRT成功撤机有重要的参考价值。Objective To investigate the application value of bedside ultrasound assessment of renal blood perfusion in patients with acute kidney injury who were weaned from continuous renal replacement therapies(CRRT).Methods A total of 45 patients requiring CRRT treatment due to Acute Kidney Injury(AKI)in ICU of our hospital were collected as study subjects.All patients underwent CRRT withdrawal test,which was deemed as success without continuing CRRT one week after withdrawal,or failure.The group A(27 cases)and the group B(18 cases)were successfully removed from the plane.Before the withdrawal test,the renal perfusion of the patients was evaluated by superb microvascular imaging(SMI)and color doppler flow imaging(CDFI).The blood perfusion score was performed by using the customized scoring criteria.The serum creatinine(CRE)level and urine volume at 24 h before the withdrawal test were recorded,and the data of the two groups were analyzed.Results CDFI score and SMI score of group A were significantly higher than those of group B,the difference was statistically significant(P<0.05);SMI score value of group A was significantly higher than CDFI score value,the difference was statistically significant(P<0.05).There were no significant differences in CRE and urine volume between the two groups(P>0.05).CDFI and SMI scores were included in ROC curve analysis of successful CRRT withdrawal test,and the area under the curve(AUC)of CDFI and SMI were 0.681 and 0.798,respectively.The sensitivity and specificity of SMI were higher than that of CDFI,and the difference was statistically significant(P<0.05).Conclusion Bedside ultrasound assessment of renal blood perfusion has important reference value for the successful weaning of CRRT in patients with AKI.

关 键 词：超声 急性肾损伤 连续性肾脏替代治疗 肾血流灌注 

分 类 号：R692[医药卫生—泌尿科学]