肾静脉多普勒模式对危重患者28 d肾功能预后的预测价值  

Predictive value of renal venous Doppler waveform pattern for 28-day renal dysfunction in critically ill patients

作　　者：支海君[1] 崔杰[1] 袁孟威 赵雅宁 赵兴文 祝亭亭 贾春梅[1] 李勇[1] Zhi Haijun;Cui Jie;Yuan Mengwei;Zhao Yaning;Zhao Xingwen;Zhu Tingting;Jia Chunmei;Li Yong(Emergency Department,Cangzhou Central Hospital,Cangzhou 061000,China)

机构地区：[1]沧州市中心医院急诊医学部,沧州061000

出　　处：《中华急诊医学杂志》2024年第3期324-331,共8页Chinese Journal of Emergency Medicine

基　　金：沧州市科技计划自筹经费项目(213106057)。

摘　　要：目的本研究旨在探讨肾动脉阻力指数(renal resistive index,RRI)、能量多普勒超声(power Doppler ultrasound,PDU)半定量评分、肾静脉多普勒波形(renal venous Doppler waveform,RVDW)模式对危重患者28 d肾功能预后的预测价值,并结合临床指标建立列线图预测模型。方法本前瞻性观察性研究纳入2018年1月至2022年10月期间于沧州市中心医院急诊重症监护室(intensive care unit,ICU)住院的危重患者作为研究对象。于入ICU 24 h内行肾脏超声检查,获得RRI、PDU评分及RVDW模式结果,并记录行超声检查时的心率、平均动脉压、血管活性药物的类型和剂量、氧疗参数以及超声检查前6 h的尿量。入组28 d进行随访,记录存活/死亡及肾功能不全持续时间。依据28 d时肾功能情况分为2组:28 d肾功能正常组及28 d肾功能不全组。28 d肾功能不全定义为入ICU 28 d未能达到肾功能恢复。比较两组间各指标的差异。通过单因素和多因素COX回归分析28 d肾功能不全的相关因素。基于与28 d肾功能不全独立相关的因素制定列线图模型。绘制生存受试者操作者特征(receiver operator characteristic,ROC)曲线评估各指标对28 d肾功能不全的预测价值,各指标曲线下面积(area under the curves,AUC)的比较采用Delong检验。结果最终共纳入187例危重患者,入组时无AKI者97例、AKI 1期48例、AKI 2期24例以及AKI 3期18例。28 d随访时,有16例患者仍存在肾功能不全,2例仍需要连续性肾脏替代治疗(continuous renal replacement therapy,CRRT)。多因素Cox风险回归分析显示,RVDW模式和入组时肌酐是28 d肾功能不全的独立影响因素。生存ROC曲线显示,RVDW模式对14 d肾功能不全[AUC=0.729,95%可信区间(confidence interval,CI)0.626-0.832,P<0.05]及28 d肾功能不全(AUC=0.771,95%CI:0.652~0.890,P<0.05)的预测价值略优于RRI及PDU,但差异无统计学意义(均P>0.05)。基于RVDW模式和入组时肌酐的列线图模型预测14 d肾功�Objective This study aimed to explore the performance of renal resistive index(RRI),semiquantitative power Doppler ultrasound(PDU)score,and renal venous Doppler waveform(RVDW)pattern in predicting 28-day renal dysfunction in critically ill patients and establish nomogram model.Methods This was a prospective,observational study.Critically ill patients admitted to the emergency intensive care unit(ICU)of Cangzhou Central Hospital from January 2018 to October 2022 were included.Patients underwent renal ultrasound examination to obtain RRI,PDU score and RVDW pattern within 24 h after ICU admission.The following clinical variables were collected during the renal ultrasound examination session,including heart rate,mean arterial pressure,type and dose of vasoactive drugs,oxygen therapy parameters,and average urine volume per hour derived from a period of 6 h prior to the ultrasound examination.The data on duration of AKI and mortality were recorded on the 28th day of follow-up.Patients were divided into 28-day normal renal function group and 28-day renal dysfunction group according to 28-day renal dysfunction.28-days of renal dysfunction was defined as failure to achieve renal function recovery within 28 days of ICU admission.The difference of each index between the two groups was compared.Associated factors for 28-day renal dysfunction were determined by univariate and multivariate COX regression analyses.A nomogram was developed based on the independently factors associated with 28-day renal dysfunction.Survival receiver operator characteristic(ROC)curves were plotted to assess diagnostic performance in predicting 28-day renal dysfunction.Delong’s test was used to compare area under the curves(AUC)between each predictor.Results 187 patients were enrolled for the final analysis:97 with no AKI,48 with AKI stage 1,24 with AKI stage 2,and 18 with AKI stage 3 upon enrollment.At 28-day follow up,16 patients had renal dysfunction and 2 required continuous renal replacement therapy(CRRT).The multivariate COX regression show

关 键 词：急性肾损伤 肾动脉阻力指数 肾能量多普勒半定量评分 肾静脉多普勒波形 重症监护室 

分 类 号：R459.7[医药卫生—急诊医学] R692[医药卫生—治疗学]