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目的探讨彩色多普勒超声在急性百草枯中毒病情判定中应用的临床意义。方法回顾性调查了我院收治的114例各型百草枯中毒的临床资料,尤其是重点分析了肾脏血流灌注、肾动脉阻力指数(RI)以及左心室收缩功能指标EF、FS、CO、SV、左室壁运动情况及其在治疗过程中的变化特点。结果 114例患者中,轻型中毒55例、中-重型中毒31例、暴发型中毒28例,共死亡36例,平均死亡率为31.6%。彩色多普勒超声检查显示:轻型中毒患者肾脏血流灌注以充满型或边缘缺损型为主,RI 0.61±0.02,左心室收缩功能指标EF(55.2±3.9)%,FS(24.8±4.2)%,左室壁运动大部分正常,仅有2例左室壁搏动轻度减弱;中-重型中毒患者肾脏血流灌注以星点型为主,少数呈边缘缺损型或无血流型,RI 0.67±0.04,EF(42.2±4.6)%,FS(21.8±3.0)%,14例左室壁运动正常,17例左室壁搏动伴不同程度减弱;暴发型中毒患者肾脏血流灌注大部分呈无血流型或星点型为主,仅1例呈边缘缺损型,RI 0.74±0.05,EF(25.2±4.3)%,FS(18.9±3.8)%,全部病例左室壁运动有不同程度减弱。轻型与中-重型、暴发型测量指标RI、EF、FS的差异有统计学意义。结论肾脏内部血流灌注情况及肾动脉RI均可反映肾功能受损害的程度,M型超声心动图通过测量左心室收缩功能指标EF、FS可提示心肌收缩功能是否受累及;肾脏血流灌注无血流型或星点型、RI>0.70、EF<30%、FS<14%提示预后差,且死亡率高,表明彩色多普勒超声在急性百草枯中毒心肾损伤程度的判断有重要临床价值。
Objective To investigate the clinical significance of color Doppler ultrasound in judging the severity of acute paraquat poisoning. Methods The clinical data of 114 cases of paraquat poisoning admitted to our hospital were retrospectively reviewed. In particular, the indexes of renal perfusion, renal artery resistance index (RI) and left ventricular systolic function indices EF, FS, CO, SV , Left ventricular wall motion and its changes in the course of treatment characteristics. Results Of the 114 patients, 55 were light poisoning, 31 were moderate-to-severe poisoning and 28 were fulminant poisonings. A total of 36 deaths occurred, with an average mortality rate of 31.6%. Color Doppler ultrasonography showed that renal perfusion in patients with mild poisoning was mainly characterized by full or marginal defect with RI 0.61 ± 0.02, left ventricular systolic function EF (55.2 ± 3.9)%, FS (24.8 ± 4.2)%, , Left ventricular wall movement most of the normal, only 2 cases of left ventricular wall beat slightly weakened; moderate to severe poisoning in patients with renal blood perfusion star-based, a few were marginal defect or no blood flow type, RI 0.67 ± 0.04, EF (42.2 ± 4.6)%, FS (21.8 ± 3.0)%, 14 cases of normal left ventricular wall motion, 17 cases of left ventricular wall beat with varying degrees of weakness; most patients with fulminant poisoning showed no renal perfusion The blood flow type or the type of the star point was the main type. Only one case showed the marginal defect type. RI 0.74 ± 0.05, EF (25.2 ± 4.3)%, FS (18.9 ± 3.8)%, all cases left ventricular wall motion weakened to varying degrees. The differences of RI, EF and FS between light and medium-heavy and outbreak type were statistically significant. Conclusion Intrarenal perfusion and renal artery RI can reflect the extent of impaired renal function. M-mode echocardiography can be used to measure whether left ventricular systolic function EF, FS can affect myocardial contractile function. Renal perfusion RI> 0.70, EF <30%, FS <14% suggest poor prognosis and high mortality, indicating that color Doppler ultrasound in acute paraquat poisoning the degree of judging the importance of cardiorespiratory clinics have important clinical value.