Morse J W, Hill R, Greissinger W P, Patterson J W, Melanson S W, Heller M B
Ann Emerg Med. 1999 Aug;34(2):134-40. doi: 10.1016/s0196-0644(99)70221-0.
To determine whether vigorous oral hydration (20 mL/kg) causes hydronephrosis as determined by bedside ultrasound.
We conducted a prospective laboratory trial in 35 healthy volunteers weighing less than 90 kg and between the ages of 18 and 50 years. The right kidney of the volunteers was scanned by emergency physicians at time 0 both before and after voiding, and the volunteers then drank 20 mL/kg of bottled water. The kidney was scanned in the transverse and sagittal planes both before and after voiding at 60 and 90 minutes after completion of the water load. The scans were interpreted by a physician trained and credentialed in emergency ultrasound, blinded to the volunteers' identity, the time of the scan, and the volume of urine voided by the subject. Images were rated as to the degree of hydronephrosis according to literature-established criteria, as follows: grade 0=no hydronephrosis, grade 1=mild, grade 2=moderate, and grade 3=severe hydronephrosis.
Hydronephrosis was present in 3 (8.6%) of the 35 subjects at time 0 (prehydration), 24 (68.6%) at 60 minutes, and 20 (57.1%) at 90 minutes. Overall, hydronephrosis occurred at least once in 28 (80%) of the 35 subjects after oral hydration compared with 3 (8.6%) of the 35 subjects before hydration. Hydronephrosis was found to be significantly related to forced hydration for all posthydration times (60 minutes, 90 minutes, and 60+90 minutes combined) versus prehydration time 0 (P <.001).
Without prior fluid intake, even mild degrees of hydronephrosis were relatively uncommon, and seen in only 8.6% of study patients. In the presence of vigorous oral hydration, however, mild or moderate hydronephrosis is a frequent occurrence seen at least once in 80% of our study of healthy volunteers after hydration. Caution is warranted in this setting when interpreting mild or moderate hydronephrosis found on bedside ultrasound by emergency physicians.
通过床边超声检查确定积极的口服补液（20毫升/千克）是否会导致肾盂积水。
我们对35名体重小于90千克、年龄在18至50岁之间的健康志愿者进行了一项前瞻性实验室试验。志愿者的右肾在排尿前后的0时刻由急诊医生进行扫描，然后志愿者饮用20毫升/千克的瓶装水。在完成饮水负荷后的60分钟和90分钟，分别在排尿前后对肾脏进行横切面和矢状面扫描。扫描结果由一名经过急诊超声培训并具备资质的医生解读，该医生对志愿者的身份、扫描时间以及受试者的排尿量不知情。根据文献确定的标准，对图像的肾盂积水程度进行分级，如下：0级=无肾盂积水，1级=轻度，2级=中度，3级=重度肾盂积水。
35名受试者中，0时刻（补液前）有3名（8.6%）出现肾盂积水，60分钟时为24名（68.6%），90分钟时为20名（57.1%）。总体而言，口服补液后，35名受试者中有28名（80%）至少出现过一次肾盂积水，而补液前35名受试者中只有3名（8.6%）出现过。与补液前的0时刻相比，在所有补液后的时间点（60分钟、90分钟以及60 + 90分钟合并），均发现肾盂积水与强制补液显著相关（P <.001）。
在没有预先摄入液体的情况下，即使是轻度肾盂积水也相对不常见，仅在8.6%的研究患者中出现。然而，在积极口服补液的情况下，轻度或中度肾盂积水很常见，在我们对健康志愿者进行的补液后研究中，至少80%的人出现过一次。当急诊医生通过床边超声发现轻度或中度肾盂积水时，在这种情况下应谨慎解读。
