经食管超声心动图评估肾静脉血流指数：心脏手术期间的准确性、变异性及其与心脏指数的关系

Assessment of Renal Vein Flow Index by Transesophageal Echocardiography: Precision, Variability, and Association with Cardiac Index During Cardiac Surgery.

作者信息

Goeddel Lee A, Hernandez Marina, Koffman Lily, Santino Chelsey, Muschelli John, Zhou Xinkai, Waldron Natalie, Parikh Chirag R, Lester Laeben, Abozaid Ravie, Faraday Nauder, Crainiceanu Ciprian M, Brown Charles

机构信息

Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.

Department of Biostatistics, Johns Hopkins School of Public Health, Baltimore, MD.

出版信息

J Cardiothorac Vasc Anesth. 2025 May 29. doi: 10.1053/j.jvca.2025.05.052.

DOI:10.1053/j.jvca.2025.05.052

PMID:40541473

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12228528/

Abstract

OBJECTIVES

Cardiac surgery-associated acute kidney injury (CSA-AKI) is a frequent and important complication often attributed to decreased kidney blood flow. Ultrasound measurement of renal vein blood flow has been associated with adverse cardiac outcomes but is understudied in cardiac surgery. The renal vein flow index (RVFI) was defined using transesophageal echocardiography (TEE) during cardiac surgery to assess its precision, variability throughout surgery, and relationship to systemic perfusion defined by the cardiac index (CI).

DESIGN

Prospective.

SETTING

University hospital.

PARTICIPANTS

Patients undergoing cardiac surgery.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

RVFI was repeatedly measured using TEE every 30 minutes throughout the entire surgery. RVFI precision was assessed using measurement error estimated from RVFI residuals and intraclass correlation coefficient. To quantify the variability of RVFI over the course of surgery, box plots with medians and interquartile ranges were assessed. The relationship between CI and RVFI was analyzed using linear regression with bootstrapping. Data from 10 participants included 324 RVFI measurements from 108 ultrasound images. The estimated measurement error was 0.030 units, which was well below the clinically meaningful threshold of 0.1 units. The intraclass correlation coefficient was 0.99 for RVSI measurements obtained within three consecutive cardiac cycles. RVFI varied across surgery (range 0-1.0 units), and each CI increase of 0.5 L/min/m was associated with a 0.058 (95% confidence interval 0.04-0.08, p < 0.001) decrease in RVFI.

CONCLUSIONS

Intraoperative measurement of RVFI by TEE has excellent precision. TEE can detect a clinically meaningful change in RVFI. RVFI varied over the course of surgery and was associated with CI, consistent with expectations for a physiological measure of renal blood flow.

摘要

目的

心脏手术相关急性肾损伤（CSA - AKI）是一种常见且重要的并发症，常归因于肾血流量减少。肾静脉血流的超声测量与不良心脏结局相关，但在心脏手术中研究较少。肾静脉血流指数（RVFI）在心脏手术期间通过经食管超声心动图（TEE）进行定义，以评估其精确性、手术全程的变异性以及与由心脏指数（CI）定义的全身灌注的关系。

设计

前瞻性研究。

地点

大学医院。

参与者

接受心脏手术的患者。

干预措施

无。

测量与主要结果

在整个手术过程中，每隔30分钟使用TEE重复测量RVFI。使用从RVFI残差估计的测量误差和组内相关系数评估RVFI精确性。为了量化手术过程中RVFI的变异性，评估了带有中位数和四分位数间距的箱线图。使用带有自抽样法的线性回归分析CI与RVFI之间的关系。来自10名参与者的数据包括来自108张超声图像的324次RVFI测量。估计的测量误差为0.030单位，远低于具有临床意义的阈值0.1单位。连续三个心动周期内获得的RVSI测量的组内相关系数为0.99。RVFI在手术过程中有所变化（范围为0 - 1.0单位），CI每增加0.5 L/min/m，RVFI降低0.058（95%置信区间0.04 - 0.08，p < 0.001）。