肾脏超声相关指标预测脓毒症休克所致急性肾损伤发生的临床价值研究  

Clinical value of ultrasound-related indicators for kidney in predicting the occurrence of septic shock-induced acute kidney injury

作　　者：潘琳[1] 李吉明[1] Pan Lin;Li Jiming(Department of Intensive Care Unit,First-aid Center,The First Affiliated Hospital of Xinjiang Medical University,Urumqi 830000,China)

机构地区：[1]新疆医科大学第一附属医院急救中心重症监护室,乌鲁木齐830000

出　　处：《中国医学装备》2025年第4期69-73,共5页China Medical Equipment

基　　金：新疆维吾尔自治区卫生健康青年医学科技人才专项科研项目(WJWY-202017)。

摘　　要：目的:研究肾脏超声监测脓毒症休克所致急性肾损伤(AKI)患者肾脏血流动力学及肾脏灌注情况,以及肾脏超声相关参数对脓毒症休克所致AKI的预测价值。方法:本研究为前瞻性研究,选择2022年9月至2023年9月新疆医科大学第一附属医院收治100例脓毒症休克患者,依据《全球肾脏病预后组织急性肾损伤临床实践指南(2012)》中的相关标准,将其分为AKI组(35例)和非AKI组(65例)。所有患者入院后均采集年龄、性别、体质量指数、合并疾病、中心静脉压、血肌酐、尿素氮、血乳酸、急性生理学与慢性健康状况评分(APACHEⅡ)及序贯器官功能衰竭评估评分(SOFA)。使用肾脏超声对患者进行肾阻力指数(RRI)以及能量多普勒超声(PDU)评分的检测,并收集峰值强度(PI)、平均渡越时间(MTT)及时间-强度曲线下面积(AUC_(TC))等指标,比较两组各扫描参数及RRI和PDU评分。结果:脓毒症休克后AKI组PI、AUC_(TC)、MTT参数及RRI评分结果均低于非AKI组,AKI组的PUD评分高于非AKI组,两组比较差异均有统计学意义(t=5.391、8.978、5.664、2.626,5.102,P<0.05),而两组患者的性别、年龄、体质量指数、合并疾病(糖尿病、高血压、冠心病)、血乳酸、急性生理与慢性健康(APACHEⅡ)评分及序贯器官衰竭评估(SOFA)评分比较差异均无统计学意义(P>0.05)。多因素分析表明,PI、AUCTC及RRI评分均是脓毒症患者发生AKI的独立影响因素(OR=0.51、0.86、0.77,P<0.05)。受试者工作特征(ROC)曲线分析结果显示,PI、AUCTC及RRI的曲线下面积分别为0.83(95%CI:0.75~0.91)、0.79(95%CI:0.70~0.88)及0.72(95%CI:0.62~0.82)。结论:肾脏超声相关指标可有效监测脓毒症休克患者肾脏血流动力学及肾脏灌注情况,可以预测AKI的发生风险,值得临床应用。Objective:To study the differences of ultrasound on kidney in monitoring renal hemodynamics and renal perfusion of patients with septic shock-induced acute kidney injury(AKI),and the predictive value of ultrasound-related parameters on kidney for septic shock-induced AKI.Methods:This is a prospective study,a total of 100 patients with septic shock who were diagnosed and treated in our hospital between September 2022 and September 2023 were selected as the study subjects.They were divided into AKI group(35 cases)and non-AKI group(65 cases)according to the relative standards of<Clinical Practice Guideline of Global Kidney Disease Prognosis for the Tissue of Acute Kidney Injury(2012)>.The age,gender,body mass index(BMI),comorbidities,central venous pressure,serum creatinine,urea nitrogen,blood lactate,Acute Physiology And Chronic Health Evaluation II(APACHE II)score,and Sequential Organ Failure Assessment(SOFA)score of all patients were collected after they admitted to hospital.Ultrasound on kidney was used to detect the renal resistive index(RRI)and power Doppler ultrasound(PDU)scores for patients,and indicators included peak intensity(PI),mean transit time(MTT),and area under curve(AUC_(TC))of the time-intensity were collected.Results:After septic shock,the PI,AUC_(TC),MTT parameter and RRI score of AKI group were lower than those of non-AKI group,while the PUD score was higher than that of non-AKI group,and the differences of them between two groups were significant(t=5.391,8.978,5.664,2.626,5.102,P<0.05).There were no significant differences in gender,age,BMI,comorbidities(diabetes,hypertension,coronary heart disease),blood lactate,APACHE II score,and SOFA score between the two groups(P>0.05).After multiple confounding factors were rectified,the results showed that PI,AUCTC and PRI scores were independent influencing factors for occurring AKI in sepsis patients(OR=0.51,0.86,0.77,P<0.05).The PI,AUCTC and RRI were used as continuous variable,and receiver operating characteristic(ROC)curve was used to analyze the p

关 键 词：肾脏超声 脓毒症 肾脏血流动力学 肾脏灌注 

分 类 号：R445.1[医药卫生—影像医学与核医学]