超声监测体外膜肺氧合支持治疗中的肾脏血流

摘要

Objective To investigate the utilization of ultrasound monitoring the renal blood flow during extracorporeal membrane oxygenation (ECMO).Methods Twentry one cases,who received veinartery ECMO for heart failure,were examinated by bed-side ultrasound before the ECMO initiated,right after the ECMO initiated,each day after the ECMO initiated,and right after the ECMO weaned.The renal interlobar artery peak velocity (Vmax) was measured,and the renal interlobar artery resistant index (RI) was calculated,as well as the values of the serum creatinine (SCr) and blood urea nitrogen (BUN) were recorded.All the data were compared.Results Compared to the variables right after the ECMO initiated,thc Vmax incrcascd (P ＜ 0.05) two days after ECMO initiated and right after the ECMO weaned,while RI (P ＜ 0.05),SCr (P ＜ 0.05) and BUN (P ＜ 0.05) decreased,there being significant differences (P ＜ 0.05).Conclusions While treating patients with extracorporeal membrane oxygenation,the ultrasound can monitoring the renal blood flow effectively,and provide important parameters for the clinical doctors as the basis of the diagnosis and treatment.%目的 探讨超声在体外膜肺氧合(ECMO)支持治疗中对肾脏血流情况的监测应用.方法 应用彩色多普勒超声显像仪,对21例因心功能衰竭(心脏术后15例,急性心肌炎6例)接受静脉-动脉ECMO治疗且合并肾功能损害,同时未接受连续性肾脏代替疗法的患者,在建立ECMO前、建立ECMO后即刻、建立ECMO后每日以及ECMO停机后即刻进行床旁肾脏超声检查,测量肾大叶间动脉峰值流速,并计算肾大叶间动脉血流阻力指数,同时记录患者血肌酐、血尿素氮,并将各次所得数据进行比较.结果 与ECMO后即刻比较,ECMO后2d及撤离ECMO后即刻的肾大叶间动脉峰值流速逐渐增高(P＜0.05),肾大叶间动脉血流阻力指数、血肌酐、血尿素氮逐渐减低,差异均有统计学意义(P＜0.05).结论 在体外膜肺氧合支持治疗中,应用超声能有效监测肾脏的血流学情况,及时为临床医生提供重要参数并作为诊疗的依据.