肾脏超声对多发伤患者急性肾损伤的早期预警价值

The value of bedside renal ultrasound in predicting acute kidney injury in patients with multiple injuries

摘要:

目的： 探讨肾脏超声对多发伤患者急性肾损伤的预测价值。方法： 入选2018年8月至2020年12月收治在南通大学附属医院急诊监护病房的多发伤患者，以床旁超声评估患者的肾脏血流分级及肾血管阻力指数（renal resistance index，RRI），将患者分为急性肾损伤（acute kidney injury，AKI）组及非AKI组，首先验证床旁肾脏超声指标与传统肾功能指标的相关性，并进一步评价肾脏超声指标在多发伤患者AKI诊断中的预测价值。结果： 与非AKI组比较，入院即刻AKI组患者的肾血流已明显下降（P<0.001），RRI明显升高（0.802±0.077 vs. 0.628±0.035，P<0.05）；AKI组患者入院即刻RRI与在院期间最差的肌酐具有良好的相关性（｜r｜=0.687），可预测AKI发生，同时与新型血清生物标记物中性粒细胞明胶酶载脂蛋白（neutrophil gelatinase associated lipids transport proteins，NGAL）显著相关（｜r｜=0.579）；ROC曲线进一步证实，RRI曲线下面积达0.984，截点值为0.675，诊断多发伤患者发生AKI的敏感度为90.9%，特异度为95.7%。结论： 对严重多发伤患者，入院即刻肾超声指标可预测AKI的发生，从而为制定肾保护性治疗措施及合理的血液净化策略提供依据，应作为ICU的常规监测项目。

Abstract:

Objective: To explore the predictive value of renal ultrasound for acute kidney injury in patients with multiple injuries. Method: Patients with multiple injuries admitted to the emergency intensive care unit of the Affiliated Hospital of Nantong University from August 2018 to December 2020 were enrolled in our study. Renal blood grades and renal resistance index（RRI） were assessed by bedside ultrasound. Patients were divided into acute kidney injury（AKI） group and non-AKI group. Firstly，we investigated the correlation between ultrasound indexes and traditional renal indexes，and further detected the value of renal ultrasound indexes in predicting AKI diagnosis and outcomes. Results: Compared with non-AKI group, renal blood flow of AKI group was significantly decreased（P<0.001），and RRI was significantly increased（0.802±0.077 vs. 0.628±0.035，P<0.05）. RRI at admission had a significant correlation with the worst creatinine during the hospitalization（｜r｜=0.687），and was consistent with the serum biomarker neutrophil gelatinase associated lipids transport proteins（|r|=0.579）. ROC curve analysis further confirmed that the area under ROC was 0.984，and the cut-off value was 0.675，indicating that the diagnosis sensitivity and specificity were 90.9% and 95.7% separately. Conclusion: Renal blood flow and RRI during the hospitalization are sensitive indicators for predicting the occurrence of AKI in patients with multiple injuries，thus providing a basis for appropriate renal protective measures and blood purification strategies，which could be used as a routine monitoring item.