摘要
目的 分析彩色多普勒超声检测感染性休克病人肾脏血流动力学参数及其对预后评估的价值。方法 回顾性分析徐州市中心医院2019年1月至2020年1月收治120例感染性休克病人病历资料,按病人急性肾损伤(AKI)程度分为无AKI组(n=23)、AKI 1~2期组(n=46)和AKI 3期组(n=51),对比三组肾血流动力学参数检查结果,分析病人肾血流动力学参数与肾功能损害的关系;依据病人预后情况分为存活组(n=52)和死亡组(n=68),分析彩色多普勒超声检测肾脏血流动力学参数与病人预后的关系。结果 与无AKI组病人相比,AKI 1~2期组和AKI 3期组病人的肾叶间动脉收缩期最大血流速度(PSV)[(34.57±5.01)cm/s、(29.32±4.53)cm/s比(54.21±7.00)cm/s]和舒张末期血流速度(EDV)[(12.18±3.01)cm/s、(9.54±2.49)cm/s比(24.87±3.59)cm/s]显著下降(P<0.05);PSV和EDV随AKI分期增加而显著下降(P<0.05),肾血管阻力指数(RI)随AKI分期增加而升高(P<0.05);PSV和EDV与感染性休克病人的AKI分期呈负相关,RI与AKI分期呈正相关。死亡组病人的EDV(11.06±3.00)cm/s显著低于存活组(16.65±5.21)cm/s(P<0.05),RI显著高于存活组(P<0.05);死亡组病人的基础疾病占比63.24%、急性生理学和慢性健康状况评价Ⅱ(APACHEⅡ)(24.87±4.77)分和多器官功能障碍综合征(MODS)评分(7.12±0.89)分均显著高于存活组[40.38%、(17.21±4.12)分、(5.37±0.54)分](P<0.05);基础疾病、APACHEⅡ评分、MODS评分、EDV以及RI均是感染性休克病人预后评估的独立危险因素(P<0.05),方差膨胀因子(VIF)均<3。结论 彩色多普勒超声检测感染性休克病人的肾脏血流动力学可反映AKI病情严重程度,可用于评估病人的预后。
Objective To analyze and study the evaluation value of color Doppler ultrasound for renal hemodynamics parameters and its prognosis in patients with septic shock.Methods The medical records of 120 patients with septic shock admitted to Xuzhou Central Hospital from January 2019 to January 2020 were retrospectively analyzed,and the patients were assigned into non-AKI group(n=23) and AKI stage 1-2 group(n=46) and AKI stage 3 group(n=51) according to the degree of acute kidney injury(AKI).The results of renal hemodynamic parameters in the three groups were compared,and the relationship between hemodynamic parameters and renal function damage were analyzed.The patients were assigned into a survival group(n=52) and a death group(n=68) according to the prognosis,and the relationship between the renal hemodynamic parameters detected by color Doppler ultrasound and the prognosis of the patients was analyzed.Results Compared with patients in the non-AKI group,the maximum systolic flow velocity(PSV) [(34.57±5.01)cm/s,(29.32±4.53) cm/s vs.(54.21±7.00) cm/s] and end-diastolic flow velocity(EDV) [(12.18±3.01) cm/s,(9.54±2.49) cm/s vs.(24.87±3.59) cm/s] in the interlobar arteries of the kidneys of patients with AKI in stage 1,2 and 3 group decreased considerably(P<0.05);PSV and EDV decreased markedly(P<0.05) and renal vascular resistance index(RI) increased with increasing AKI stage(P<0.05);PSV and EDV were negatively correlated with AKI stage in patients with infectious shock,and RI was positively correlated with AKI stage.EDV(11.06±3.00) cm/s of death group was significantly lower than that of the surviving group(16.65±5.21) cm/s(P<0.05),and the RI level was dramatically higher than that of the surviving group(P<0.05).The percentage of the underlying disease(63.24%),the acute Physiology and Chronic Health Score(APACHEⅡ)(24.87±4.77) and Multiple Organ Dysfunction Syndrome(MODS) score(7.12±0.89) in death group were notably higher than those in the surviving group(40.38%,17.21±4.12 and 5.37±0.54)(P<0.05).Underlying diseases,APACHEⅡ score,MODS score,EDV and RI were all independent risk factors for the prognosis of patients with septic shock(P<0.05),and variance inflation factor(VIF) values were all lower than 3.Conclusion Color Doppler ultrasound detection of renal hemodynamics in patients with septic shock can reflect the severity of AKI and can be used to evaluate the prognosis of patients.
作者
徐维
许继元
李茂琴
曹健锋
朱莎莎
XU Wei;XU Jiyuan;LI Maoqin;CAO Jianfeng;ZHU Shasha(Department of Critical Care Medicine,Xuzhou Central Hospital,Xuzhou,Jiangsu 221000,China)
出处
《安徽医药》
CAS
2024年第3期581-585,共5页
Anhui Medical and Pharmaceutical Journal
基金
徐州市科技项目(KC22162)。
