肾阻力指数在预测失血性休克液体复苏后急性肾损伤的价值

发布时间：2018-09-19 07:54

【摘要】：目的评价肾脏血流阻力指数(RRI)在失血性休克液体复苏后急性肾损伤(AKI)的预测价值。方法选取收治的严重多发伤合并失血性休克患者,根据术后3 d是否出现AKI分为3组,A组为术后无AKI,B组为一过性AKI,C组为持续性AKI。患者入院后采用ISS评分评估患者病情严重程度,比较术前(T1)、术后(T2)、术后72 h(T3)的血乳酸(Lac)、剩余碱(BE)、肌酐(Cr)值和RRI值。结果 3组患者年龄、性别、体质指数差异无统计学意义(P0.05);3组间的ISS评分差异有统计学意义(P0.001)。B组T2时间点Cr值高于T1,但在T3时Cr值显著下降(P0.05)。C组患者T1、T2、T3的Cr值逐渐上升(P0.001)。3组患者在T1时RRI值比较差异有统计学意义(P0.05),其中A组小于B、C组(P0.05),而B、C组之间差异无统计学意义(P0.05);T2和T3时间点3组间RRI值差异有统计学意义(P0.001),C组高于B组和A组。A和B两组在T2、T3时间均呈下降趋势,而C组T1、T2、T3三个时间点之间差异无统计学意义(P0.05)。T2时间点RRI值预测持续性AKI,ROC曲线下面积为0.815,诊断持久性AKI的RRI临界值为0.753,预测持续性AKI敏感度为73.9%,特异度为74.2%。结论 RRI是简便无创的肾功能评价指标,可作为失血性休克液体复苏的参考指标,对液体复苏后AKI具有良好的预测评估作用。
[Abstract]:Objective To evaluate the value of renal blood flow resistance index (RRI) in predicting acute renal injury (AKI) after fluid resuscitation in hemorrhagic shock.Methods Patients with severe multiple trauma complicated with hemorrhagic shock were divided into three groups according to whether AKI occurred 3 days after operation. Results There was no significant difference in age, sex and body mass index among the three groups (P 0.05). There was a significant difference in ISS score among the three groups (P 0.001). The value of Cr in group B at T2 was higher than that in T1, but at T3. The RRI values of T1, T2 and T3 in group C increased gradually (P 0.001). The RRI values of group A were lower than those of group B, group C (P 0.05), but there was no significant difference between group B and group C (P 0.05). The RRI values of group C were higher than those of group B and group A (P 0.001). There was no significant difference between group C and group B at T1, T2 and T3 time points (P 0.05). RRI value at T2 time point predicted persistent AKI, ROC area under curve was 0.815, the critical value for diagnosing persistent AKI was 0.753, and the sensitivity and specificity for predicting persistent AKI were 73.9% and 74.2%, respectively. Renal function evaluation index can be used as a reference index for fluid resuscitation of hemorrhagic shock and has a good predictive evaluation effect on AKI after fluid resuscitation.
【作者单位】：梧州市红十字会医院重症医学科;东莞东华医院重症医学科;东莞市塘厦医院重症医学科;
【基金】：东莞市医疗卫生科技计划一般项目(编号:2015105101221)
【分类号】：R459.7

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