Qin Huai, Wu Haibo, Chen Yi, Zhang Nan, Fan Zhanming
Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China.
Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China.
J Ultrasound Med. 2017 Oct;36(10):2105-2111. doi: 10.1002/jum.14236. Epub 2017 Jun 6.
This study aimed to evaluate the early efficiency of Doppler renal resistive index (DRRI) in prediction of acute kidney injury (AKI) after surgery in acute Stanford Type A aortic dissection (AAAD) patients.
Sixty-one AAAD patients who planned to receive Sun's surgical management were prospectively enrolled. The DRRI was measured by ultrasonography Doppler on the day before surgery (DRRI ), on admission to the intensive care unit (DRRI ), 6 hours after surgery (DRRI ), 24 hours after surgery (DRRI ), and 48 hours after surgery (DRRI ). The maximum DRRI value (DRRI ) was recorded. The AKI was evaluated according to the classifications of the Acute Kidney Injury Network. The DRRI and serum creatinine (sCr) were compared between the pre- and postoperative time stations, as well as between the AKI and no-AKI groups.
Thirty-nine (63.9%) patients suffered from AKI, and 12 (19.6%) patients received dialysis. No significant difference was found in DRRI (0.63 ± 0.04 versus 0.65 ± 0.06, P = .059) and sCr (84.13 ± 23.77 versus 94.29 ± 51.11, P = .383) between the two groups with and without AKI. Both the DRRI and sCr increased significantly after surgery in the AKI groups (P < .001). However, the DRRI reached its maximum 6 hours after surgery, whereas the sCr reached its maximum after 24 hours. Both the DRRI and sCr improved 48 hours after surgery. The area under the receiver operating characteristic curve for DRRI (0.864, 95% confidence interval: 0.770-0.957) and DRRI (0.861, 95% confidence interval: 0.766-0.957) was larger than the other three DRRIs measured at different time points. The cutoff value of DRRI was 0.71, a sensitivity of 76.9% and specificity of 95.5%.
Postoperative DRRI predicts the AKI earlier than sCr after AAAD surgery. The best time to detect DRRI was 6 hours after surgery.
本研究旨在评估多普勒肾阻力指数（DRRI）对急性Stanford A型主动脉夹层（AAAD）患者术后急性肾损伤（AKI）的早期预测效能。
前瞻性纳入61例计划接受孙氏手术治疗的AAAD患者。于术前1天（DRRI ）、重症监护病房入院时（DRRI ）、术后6小时（DRRI ）、术后24小时（DRRI ）及术后48小时（DRRI ）采用超声多普勒测量DRRI。记录DRRI最大值（DRRI ）。根据急性肾损伤网络的分类评估AKI。比较术前和术后各时间点以及AKI组和非AKI组的DRRI和血清肌酐（sCr）。
39例（63.9%）患者发生AKI，12例（19.6%）患者接受透析治疗。AKI组和非AKI组之间的DRRI（0.63±0.04对0.65±0.06，P = 0.059）和sCr（84.13±23.77对94.29±51.11，P = 0.383）无显著差异。AKI组术后DRRI和sCr均显著升高（P < 0.001）。然而，DRRI在术后6小时达到最大值，而sCr在术后24小时达到最大值。术后48小时DRRI和sCr均有所改善。DRRI（0.864，95%置信区间：0.770 - 0.957）和DRRI（0.861，95%置信区间：0.766 - 0.957）的受试者工作特征曲线下面积大于在不同时间点测量的其他三个DRRI。DRRI的截断值为0.71，灵敏度为76.9%，特异度为95.5%。
AAAD术后DRRI比sCr能更早预测AKI。检测DRRI的最佳时间为术后6小时。
