目的:目的是使用超声和超声造影来量化脓毒症急性肾损伤(AKI)患者的宏观肾血流量和肾皮质微循环。
方法:在本病例对照研究中,根据2012年KDIGO(肾脏疾病:改善全球结局)AKI诊断标准,将重症监护病房诊断为脓毒性AKI的患者分为1~3期.患者分为轻度(1期)和重度(2期和3期)组,而无AKI的脓毒症患者作为对照组。超声参数,如大血管肾血流量和时间平均速度,以及心脏功能参数,如心输出量和心脏指数,被测量。通过超声造影成像软件分析微循环中的时间-强度曲线,计算峰值时间等成像参数,上升时间,肾皮质叶间动脉的下降半衰期和平均通过时间。
结果:就宏观循环而言,随着脓毒症急性肾损伤的进展,肾血流量和时间平均速度逐渐降低(p=0.004,p<0.001)。三组之间的心输出量和心脏指数值没有差异(p=0.17和p=0.12)。在微循环方面,肾皮质小叶间动脉的超声多普勒参数,如峰强度,收缩期峰值血流速度与舒张末期血流速度之比,逐渐增加(所有p值<0.05)。时间对比增强超声参数-到达峰值的时间,上升时间,与对照组相比,AKI组的跌倒半衰期和平均通过时间延长(分别为p<0.001,p=0.003,p=0.004和p=0.009)。
结论:在感染性AKI患者中,肾脏血流和大循环的时间平均速度降低,而微循环的时间参数,如达到峰值的时间,上升时间,下降半衰期和平均运输时间延长,尤其是严重AKI患者。这些变化与心输出量或心指数的变化无关。
The aim was to quantify macroscopic renal blood flow and renal cortical microcirculation in patients with septic acute kidney injury (AKI) using ultrasound and contrast-enhanced ultrasound.
In this case-control study, patients in the intensive care unit diagnosed with septic AKI were divided into stages 1-3 based on the 2012 KDIGO (Kidney Disease: Improving Global Outcomes) AKI diagnostic criteria. The patients were categorized into mild (stage 1) and severe (stages 2 and 3) groups, while septic patients without AKI served as the control group. Ultrasound parameters such as macrovascular renal blood flow and time-averaged velocity, as well as cardiac function parameters such as cardiac output and cardiac index, were measured. The time-intensity curve in the microcirculation was analyzed through contrast-enhanced ultrasound imaging software to calculate imaging parameters such as peak time, rise time, fall half-time and mean transit time of the interlobar arteries in the renal cortex.
In terms of
macrocirculation, renal blood flow and time-averaged velocity decreased gradually with the progression of septic acute renal injury (p = 0.004, p < 0.001). There was no difference in cardiac output and cardiac index values among the three groups (p = 0.17 and p = 0.12). In terms of microcirculation, ultrasonic Doppler parameters of the renal cortical interlobular artery, such as peak intensity, risk index and ratio of peak systolic velocity to end-diastolic velocity, gradually increased (all p values <0.05). The temporal contrast-enhanced ultrasound parameters-time to peak, rise time, fall half-time and mean transit time-were prolonged in AKI groups when compared with the control group (p < 0.001, p = 0.003, p = 0.004 and p = 0.009, respectively).
In patients with septic AKI, the renal blood flow and time average velocity of
macrocirculation in the kidneys are reduced, while the time parameters of microcirculation such as time to peak, rise time, fall half-time and mean transit time are prolonged, especially in patients with severe AKI. These changes are not related to changes in cardiac output or cardiac index.