急性Stanford A型主动脉夹层术后急性肾损伤的肾叶间动脉血流动力学改变

摘要

Objective To explore the changes of hemodynamics in acute kidney injury (AKI) after acute severe Stanford type A aortic dissection.Methods Forty patients with acute Stanford A type aortic dissection were enrolled.Arterial peak systolic velocity (PSV),end diastolic velocity (EDV),pulsative index (PI),resistive index (RI),Serum creatinine (SCr) and urine volume were recorded and measured 1 day before operation,immediately after operation (enter the intensive care unit),6 h after operation,24 h after operation and 48 h after operation.Patients were divided into AKI group and non-AKI.group taking AKIN as a standard.Results Twenty-seven patients were in AKI group and 13 were in non-AKI group.The EDV,PI and RI had significantly differences between AKI group and non-AKI group at 6 h,24 h after operation.Correlation analysis showed that EDV negatively correlated with SCr (r=-0.508,P=0.001),while PI,RI positively correlated with SCr (r=0.411,0.443,P=0.009,0.005).Conclusion EDV,PI and RI in the interlobular arteries can be used to predict AKI early in the interosseous arteries,and the optimal time for ultrasonic measurement of renal arterial hemodynamics to predict is at 6 h and 24 h after operation.%目的 探讨急性Stanford A型主动脉夹层术后急性肾损伤(AKI)的超声血流动力学指标改变情况.方法 收集40例接受手术治疗的急性Stanford A型主动脉夹层患者,分别在手术前1天、术后即刻(进人重症监护室)、手术后6、24、48 h测量双肾叶间动脉收缩期峰值流速(PSV)、舒张期最小流速(EDV)、搏动指数(PI)、阻力指数(RI),同时记录血肌酐(sCr)水平和尿量.以AKIN为标准将患者分为AKI组和无AKI组,比较两组间差异.结果 40例患者中,AKt组27例,无AKI组13例.无AKI组与AKI组患者术后6、24 h肾叶间动脉EDV、PI、RI差异有统计学意义(P均＜0.05).肾叶间动脉EDV与sCr呈负相关(r=-0.508,P=0.001),PI、RI与SCr呈正相关(r=0.411、0.443,P=0.009、0.005).结论 通过肾叶间动脉EDV、PI、RI可早期预测AKI发生,术后6、24 h是超声测量肾叶间动脉血流动力学指标预测肾损伤的最佳时间.