Department of Intensive Care Unit, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China.
Eur Rev Med Pharmacol Sci. 2020 Dec;24(23):12450-12460. doi: 10.26355/eurrev_202012_24040.
This study aimed to explore the significance of renal Doppler ultrasound in evaluating systemic and renal perfusion in sepsis patients before and after fluid resuscitation.
Forty sepsis patients admitted to the Department of Intensive Medicine and intensive care unit (ICU) of the Fourth Hospital of Hebei Medical University from June 2014 to December 2014 were enrolled in this study, and 35 patients were included in the final analysis. These patients were divided into positive and negative fluid responsiveness groups. They were also divided into an acute kidney injury (AKI) group and a non-AKI group according to changes in creatinine and urine volume. The correlations of the changes in hemodynamics before and after fluid resuscitation in each group with the changes in renal resistance index (RRI) and renal blood flow (RBF) grades were evaluated.
Before and after fluid resuscitation, the heart rate (HR), blood creatinine (Cre), and lactate (Lac) levels of all patients, including the patients in the positive fluid responsiveness group decreased, and the stroke volume (SV) and central venous pressure (CVP) increased. Only HR decreased in the negative fluid responsiveness group. In the AKI group, HR, Cre, and Lac decreased, while in the non-AKI group, HR decreased, but CVP and SV increased. There were differences between HR, Lac, and change rate of Lac (Lac%) after fluid resuscitation for the positive and negative fluid responsiveness groups. There was no statistical difference between the RRI values of each group before and after fluid resuscitation. The RRI values of the AKI group were higher than those of the non-AKI group, while the AKI group's RBF grades were lower than those of the non-AKI group. The change rate of RRI (RRI%) was higher in the AKI group than in the non-AKI group. Except for the negative fluid responsiveness group, the RBF grade of each group increased.
The approach of RBF classification based on Doppler ultrasound can be used to evaluate the systemic and renal perfusion of patients with severe sepsis before and after fluid resuscitation, while the RRI value cannot be used for evaluation. However, the RRI value can be used as a dynamic index for the evaluation of renal perfusion in patients with AKI.
本研究旨在探讨肾多普勒超声在评估脓毒症患者液体复苏前后全身和肾灌注中的意义。
选取 2014 年 6 月至 2014 年 12 月河北医科大学第四医院重症医学科和重症监护病房收治的 40 例脓毒症患者，其中 35 例患者进入最终分析。这些患者被分为有液体反应性和无液体反应性两组。根据肌酐和尿量的变化，他们还被分为急性肾损伤（AKI）组和非 AKI 组。评估每组患者液体复苏前后血流动力学变化与肾阻力指数（RRI）和肾血流（RBF）分级变化的相关性。
所有患者，包括有液体反应性组和无液体反应性组，在液体复苏前后心率（HR）、血肌酐（Cre）和乳酸（Lac）水平降低，而每搏量（SV）和中心静脉压（CVP）升高。无液体反应性组的 HR 降低。AKI 组 HR、Cre 和 Lac 降低，而非 AKI 组 HR 降低，但 CVP 和 SV 升高。有液体反应性和无液体反应性组的 HR、Lac 和 Lac 变化率（Lac%）在液体复苏后有差异。各组患者的 RRI 值在液体复苏前后无统计学差异。AKI 组的 RRI 值高于非 AKI 组，而 AKI 组的 RBF 分级低于非 AKI 组。AKI 组的 RRI 变化率（RRI%）高于非 AKI 组。除无液体反应性组外，其他组的 RBF 分级均升高。
基于多普勒超声的 RBF 分级方法可用于评估严重脓毒症患者液体复苏前后的全身和肾灌注，而 RRI 值不能用于评估。然而，RRI 值可用作评估 AKI 患者肾灌注的动态指标。
