肾搏动指数可有效预测脓毒症相关急性肾损伤

彭誉.肾搏动指数可有效预测脓毒症相关急性肾损伤[J].内科急危重症杂志,2021,27(3):209-212

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DOI：10.11768/nkjwzzzz20210308

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基金项目:苏州市“科技兴卫”青年科技项目（No:KJXW2016032）

作者	单位	E-mail
彭誉	南京医科大学附属苏州医院重症医学科	522904430@qq.com

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中文摘要:

目的：探讨肾搏动指数（PI）在脓毒症相关急性肾损伤（AKI）患者早期诊断价值。方法：回顾性分析2019年3-11月南京医科大学附属苏州医院重症医学科收治的脓毒症患者48例，分为发生AKI者33例（AKI组），未发生AKI者15例（非AKI组）。AKI患者以7d内肾损伤程度，按照改善全球肾脏病预后组织（KDIGO）标准将AKI组进一步分为AKI 1期组（11例）、AKI 2期组（15例）、AKI 3期组（7例）。收集患者的基线资料，连续7 d同一时间床旁超声测量每例患者右肾叶间动脉的PI，同时记录患者每天的急性生理与慢性健康状况评估（APACHEⅡ）评分、平均动脉压（MAP）、中心静脉压（CVP）、动脉血乳酸（Lac）、氧合指数（OI）、血清肌酐（SCr）水平及去甲肾上腺素（NE）用量进行统计分析。结果：AKI组患者PI高于非AKI组；AKI 2期组、AKI 3期组的PI显著高于AKI 1期组，且AKI 3期组高于AKI 2期组，差异有统计学意义（P均＜0.05）。相关分析显示，PI与SCr、NE用量、Lac及APACHEⅡ评分呈正相关，与OI、CVP、MAP呈负相关。多因素Logistic回归分析显示，PI是AKI分级的独立影响因素 [优势比（OR）=3.32,95%可信区间（95%CI）=1.32~4.38]，CVP和Lac也与AKI分级相关 [OR值分别为4.01（95%CI=1.25～13.00）、5.98（95%CI=1.68～8.75）]。ROC曲线分析显示，PI预测脓毒症患者发生AKI的曲线下面积（AUC）为0.80（P<0.05）；以PI＞1.2预测脓毒症患者发生AKI的敏感度为83%，特异度为62%。结论：脓毒症患者早期高PI提示可能合并AKI，且PI值越高，提示AKI越严重。

英文摘要:

Objective: To investigate the value of renal pulsation index (PI) in the early diagnosis of sepsis-related acute kidney injury (AKI). Methods:A retrospective analysis of 48 patients with sepsis admitted to the Department of Critical Care Medicine, Suzhou Hospital of Nanjing Medical University from March to November, 2019, were divided into AKI group (n=33) and non-AKI group (n=15). According to the standard of KDIGO, AKI patients were divided into three groups: AKI stage 1 (11 cases), AKI stage 2 (15 cases) and AKI stage 3 (7 cases). The baseline data of each patient were collected, the right renal interlobar artery pulse index of each patient was measured beside bed for consecutive 7 days at the same time, and the daily acute physiology and chronic health score Ⅱ (APACHE Ⅱ), mean arterial pressure (MAP), central venous pressure (CVP), arterial lactate (LAC), oxygenation index (OI), serum creatinine (SCr), and noradrenaline (NE) were recorded. Results: The PI in the AKI group was higher than that in the non-AKI group. The PI in the AKI 2 and AKI 3 groups was significantly higher than in the AKI 1 group, and that in the AKI 3 group was higher than in the AKI 2 group with the difference being statistically significant (all P< 0.05). Correlation analysis showed that PI was positively correlated with the scores of SCr, NE dosage, LAC and APACHE Ⅱ, and negatively correlated with OI, CVP and MAP. Multivariate factor Logistic regression analysis showed that PI was the independent influencing factor of AKI \[odds ratio (OR) = 3.32, 95% confidence interval (95% CI) = 1.32-4.38)\]. CVP and LAC were also associated with AKI classification \[OR= 4.01 (95% CI=1.25-13.00), 5.98 (95% CI=1.68-8.75)\]. The ROC curve analysis showed that the AUC of PI was 0.80 (P< 0.05); When PI > 1.2 was used to predict AKI in sepsis patients, the sensitivity was 83%, and the specificity was 62%. Conclusion:High PI in the early stage of sepsis suggests the possibility of AKI, and the higher PI, the more serious AKI.