肾动脉阻力指数在重症患者腹高压诊断中的应用价值  

Application value of renal artery resistance index in the diagnosis of intra-abdominal hypertension in critically ill patients

作　　者：陈宝泉 陈明 徐锦洋 吕国荣 杨燕芬 杨舒萍 Chen Baoquan;Chen Ming;Xu Jinyang;Lyu Guorong;Yang Yanfen;Yang Shuping(Department of Ultrasound,Zhangzhou Hospital Affiliated to Fujian Medical University,Zhangzhou 363000,China;Collaborative Innovation Center of Maternal and Child Health Service Application Technology,Quanzhou Medical College,Quanzhou 362000,China)

机构地区：[1]福建医科大学附属漳州市医院超声医学科,漳州363000 [2]泉州医学高等专科学校母婴健康服务应用技术协同创新中心,泉州362000

出　　处：《中华急诊医学杂志》2024年第3期360-364,共5页Chinese Journal of Emergency Medicine

摘　　要：目的探讨肾动脉阻力指数(resistance index,RI)在重症患者腹高压(intra-abdominal pressure,IAH)诊断中的应用价值。方法回顾性分析2022年2月至2022年6月入住漳州市医院重症监护室具有IAH危险因素的89名患者,根据经膀胱测得的腹内压(IAP)分为IAH组(IAP≥12 mmHg)和非IAH组(IAP<12 mmHg),应用彩色多普勒超声测量右肾主动脉、段动脉、叶间动脉的RI值,分析IAH组与非IAH组患者各测量参数的差异性及其与IAP的相关性。对不同指标预测IAH的诊断效能,采用ROC曲线分析进行评估,并同时行多因素Logistic回归分析寻找独立危险预测因子。结果总共有89名患者纳入研究,44例IAP正常,45例诊断为IAH。IAH组与非IAH组相比,右肾主动脉、段动脉、叶间动脉RI均差异具有统计学意义(均P<0.01),其中以叶间动脉RI≥0.698为诊断截值时诊断效能最高,曲线下面积0.914,敏感度82.2%,特异度97.7%,约登指数0.799;Spearman相关性分析显示右肾叶间动脉RI与IAP具有较强的相关性(r=0.741,P<0.01)。多因素Logistic回归分析结果显示右肾叶间动脉RI值(OR=24.472,95%CI:5.122~116.919,P<0.01)是IAH的独立危险预测因子。结论右肾叶间动脉RI值诊断IAH有较好的诊断效能,肾动脉超声可以作为诊断和随访IAH的一种替代的、非侵入性的技术。Objective To explore the application value of renal artery resistance index in the diagnosist of intra-abdominal hypertension(IAH)in critically ill patients.Methods 89 patients with risk factors of IAH in the intensive care unit of Zhangzhou Hospital Affiliated to Fujian Medical University from February 2022 to June 2022 were retrospective analyzed.The intra-abdominal pressure(IAP)were measured by bladder,and patients divided into IAH group(IAP≥12 mmHg)and non-IAH group(IAP<12 mmHg).The resistance index(RI)of the right renal aorta,segment artery and interlobar artery were measured by color Doppler ultrasound.The difference between the measurement indicators of patients in the IAH and non-IAH groups and the correlation with IAP were analyzed.As for different indicators to predict the diagnostic efficacy of IAH,ROC curve analysis was used to evaluate the effect.And further multivariate logistic regression analysis was to find independent risk predictor.Results A total of 89 patients were included in the study,including 44 patients with normal IAP and 45 patients diagnosed IAH.There were significant differences in the right renal aorta,segmental artery and interlobar artery RI(all P<0.01).The interlobar artery RI≥0.698 was the highest diagnostic cut-off,area under the curve was 0.914,sensitivity was 82.2%,specificity was 97.7%,and Jordon index was 0.799.The Spearman correlation analysis of IAP and the ultrasonographic measurements revealed a strong correlation between right renal interlobar artery RI and IAP(r=0.741,P<0.01).The multivariate logistic regression analysis showed that the right renal interlobar artery RI(OR=24.472,95%CI:5.122~116.919,P<0.01)was an independent risk predictor of IAH(P<0.01).Conclusion Right renal interlobar artery RI had better diagnostic efficacy of IAH,renal ultrasound could be used as an alternative,non-invasive technique for the diagnosis and followup of IAH.

关 键 词：超声 肾动脉 阻力指数 重症患者 腹高压 

分 类 号：R459.7[医药卫生—急诊医学]