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目的通过探测肾血流的超声变化,明确超声在重症全身性感染患者急性肾损害(AKI)早期诊断中的意义。方法选取2009年3月至2010年12月入住首都医科大学附属复兴医院重症监护病房(ICU)且首次诊断为重症全身性感染的31例患者,共计62只肾,于诊断后首个24h内,达到血流动力学稳定时,超声测量肾脏大小、肾脏上中下三极叶间动脉的收缩期峰值流速(Vmax)、舒张期峰值流速(Vmin)、阻力指数(RI)、肾血管搏动指数(PI)。常规实验室检测血肌酐(Scr)值。31例重症全身性感染患者中,根据第5天Scr水平诊断急性肾损害15例(AKI组),非急性肾损害16例(非AKI组)。第5天再次测量上述指标并进行对比分析。结果后期分析显示,AKI组肾叶间动脉RI值第1天即较非AKI组明显增高(0.721vs.0.696,P<0.01),而此时两组间Scr值差异并无统计学意义。结论通过超声检测肾叶间动脉RI值,可以为重症全身性感染患者早期诊断AKI提供客观依据。
Objective To explore the significance of ultrasound in the early diagnosis of acute renal injury (AKI) in patients with severe systemic infection by detecting the ultrasonic changes of renal blood flow. Methods From March 2009 to December 2010, 31 patients admitted to the Intensive Care Unit (ICU) of Fuxing Hospital Affiliated to Capital Medical University who were diagnosed with severe systemic infection for the first time, a total of 62 kidneys were recruited in the first 24 hours after diagnosis When hemodynamics was stable, the size of kidney, the peak systolic velocity (Vmax), the diastolic peak velocity (Vmin), the resistance index (RI) and the index of renal artery pulsatility ). Routine laboratory test serum creatinine (Scr) value. Among 31 patients with severe systemic infection, 15 cases of acute renal injury (AKI group) and 16 cases of non-acute renal damage (non-AKI group) were diagnosed on the 5th day of Scr level. On the fifth day, the above indexes were measured again and compared. Results The late analysis showed that the RI of AKI group was significantly higher than that of non-AKI group on the first day (0.721 vs.0.696, P <0.01), while there was no significant difference in Scr between the two groups. Conclusion Ultrasound detection of interrenal artery RI value can provide an objective basis for the early diagnosis of AKI in patients with severe systemic infection.