论文部分内容阅读
目的探讨能量多普勒超声(PDU)半定量评分在围术期重症妊娠期高血压患者急性肾损伤(AKI)早期诊断中的应用价值。方法选择围术期重度妊娠期高血压孕产妇患者60例作为研究对象,连续监测在进入重症监护病房(ICU)后的0、6、12、18和24 h使用超声测量患者的肾脏阻力指数(RI)、PDU半定量得分等血流动力学参数以及BUN、Cr等指标,根据患者进入ICU 72 h后的临床表现分为AKI组和非AKI组,比较两组患者在入室第1天0、6、12、18、24 h的RI以及上述时间段内PDU的平均值与AKI发生的相关关系。结果 AKI组患者在24 h内尿素氮(BUN)和肌酐(Cr)指标变化不明显,但是RI和PDU却有统计学差异(P<0.05),并且RI与平均PDU之间有负相关关系(|r|>0.70);12、18和24 h内PDU平均得分的ROC曲线下面积(AUC)分别为0.836、0.880和0.894,切入点分别为2.17、2.13和2.30。结论围手术期重度妊娠期高血压孕产妇在AKI发生之前,RI和PDU等血流动力学参数会发生明显变化,进入ICU后12 h的平均PDU得分低于2可以作为AKI早期诊断的依据。
Objective To investigate the value of semi-quantitative assessment of energy Doppler ultrasound in the early diagnosis of acute renal injury (AKI) in patients with severe gestational hypertension during perioperative period. Methods Sixty pregnant women with severe gestational hypertension during perioperative period were enrolled in this study. The renal resistance index of the patients were measured by ultrasound at 0, 6, 12, 18 and 24 h after ICU admission RI), semi-quantitative score of PDUs and hemodynamics parameters such as BUN and Cr were divided into AKI group and non-AKI group according to clinical manifestations 72 h after ICU admission, RI at 6, 12, 18, 24 h and the correlation between the mean of PDUs and AKI during the above time period. Results There was no significant change of BUN and Cr in patients with AKI within 24 hours, but there was a significant difference between RI and PDU (P <0.05) and there was a negative correlation between RI and average PDU ( | r |> 0.70). The area under the ROC curve (AUC) of PDU average scores within 12, 18 and 24 h were 0.836, 0.880 and 0.894 respectively, and the entry points were 2.17, 2.13 and 2.30 respectively. Conclusion Prior to the onset of AKI, the hemodynamic parameters of RI and PDU may change significantly in perioperative pregnant women with severe gestational hypertension. The mean PDI of 12 h after ICU admission may be used as the basis for early diagnosis of AKI.