Department of Intensive Care Adults, Erasmus MC, Rotterdam, The Netherlands.
Department of Biomedical Engineering, Thorax Center, Erasmus MC, Rotterdam, The Netherlands.
Crit Care Med. 2018 Aug;46(8):1284-1292. doi: 10.1097/CCM.0000000000003209.
We developed quantitative methods to analyze microbubble kinetics based on renal contrast-enhanced ultrasound imaging combined with measurements of sublingual microcirculation on a fixed area to quantify early microvascular alterations in sepsis-induced acute kidney injury.
Prospective controlled animal experiment study.
Hospital-affiliated animal research institution.
Fifteen female pigs.
The animals were instrumented with a renal artery flow probe after surgically exposing the kidney. Nine animals were given IV infusion of lipopolysaccharide to induce septic shock, and six were used as controls.
Contrast-enhanced ultrasound imaging was performed on the kidney before, during, and after having induced shock. Sublingual microcirculation was measured continuously using the Cytocam on the same spot. Contrast-enhanced ultrasound effectively allowed us to develop new analytical methods to measure dynamic variations in renal microvascular perfusion during shock and resuscitation. Renal microvascular hypoperfusion was quantified by decreased peak enhancement and an increased ratio of the final plateau intensity to peak enhancement. Reduced intrarenal blood flow could be estimated by measuring the microbubble transit times between the interlobar arteries and capillary vessels in the renal cortex. Sublingual microcirculation measured using the Cytocam in a fixed area showed decreased functional capillary density associated with plugged sublingual capillary vessels that persisted during and after fluid resuscitation.
In our lipopolysaccharide model, with resuscitation targeted at blood pressure, contrast-enhanced ultrasound imaging can identify renal microvascular alterations by showing prolonged contrast enhancement in microcirculation during shock, worsened by resuscitation with fluids. Concomitant analysis of sublingual microcirculation mirrored those observed in the renal microcirculation.
我们开发了定量分析方法，基于肾增强超声成像，结合对固定区域舌下微循环的测量，分析脓毒症诱导的急性肾损伤中早期微血管改变。
前瞻性对照动物实验研究。
医院附属动物研究机构。
15 头雌性猪。
通过手术暴露肾脏后，对动物的肾动脉血流探头进行了仪器操作。9 只动物给予静脉内脂多糖输注以诱导脓毒性休克，6 只作为对照。
在休克诱导前后对肾脏进行了超声造影成像。在同一部位使用 Cytocam 连续测量舌下微循环。超声造影有效地使我们能够开发新的分析方法来测量休克和复苏过程中肾微血管灌注的动态变化。肾微血管低灌注通过降低峰值增强和增加终板强度与峰值增强的比值来量化。通过测量肾皮质间叶动脉和毛细血管之间的微泡渡越时间，可以估计肾内血流减少。使用 Cytocam 在固定区域测量的舌下微循环显示功能毛细血管密度降低，与阻塞性舌下毛细血管有关，这种情况在液体复苏期间和之后持续存在。
在我们的脂多糖模型中，以血压为目标的复苏，超声造影成像可以通过显示休克期间微循环中对比增强的延长来识别肾微血管改变，液体复苏会使情况恶化。同时对舌下微循环的分析反映了在肾微循环中观察到的情况。
