CAJ | 학술논문

目的探讨主动脉夹层(AD)患者的肾脏CT灌注特点,分析破口大小、数目及位置与肾血流量的关系.方法采用AQUILION ONE 320排CT,对22例超声诊断AD的患者,术前进行双肾血流灌注检查(5 ml/s,50 ml,320 mg I/ml),同时行胸腹部大血管CT血管造影检查,测量肾血流量参数值,并观察AD内膜破口的位置、大小及数目,比较分析患者破口大小、数目及位置与肾血流量的关系.结果 22例患者中,只有1个破口者15例,破口大小(16±9)mm;≥2个破口者7例,破口大小(6±3)mm.破口位于左锁骨下动脉以远(B型)16例,破口位于升主动脉(A型)6例.只有1个破口者肾血流量平均为(280±77) ml/(min· 100 ml),A型AD患者肾血流量平均值低于B型[(210±32)ml/(min·100 ml)比(292±43)ml/(min·100 ml),P＜0.01],破口大小与肾血流量高度相关(r=0.968,P=0.000);≥2个破口者肾血流量平均为(246±63)ml/(min·100 ml).随破口数量增多,患者肾血流量平均值升高(P＜0.05),肾动脉起源于假腔侧肾灌注优于真腔侧(P＜0.05).结论 AD患者内膜破口大小及数目、位置是影响肾动脉灌注的重要因素.
목적 탐토주동맥협층(AD)환자적신장CT관주특점,분석파구대소、수목급위치여신혈류량적관계.방법 채용AQUILION ONE 320배CT,대22례초성진단AD적환자,술전진행쌍신혈류관주검사(5 ml/s,50 ml,320 mg I/ml),동시행흉복부대혈관CT혈관조영검사,측량신혈류량삼수치,병관찰AD내막파구적위치、대소급수목,비교분석환자파구대소、수목급위치여신혈류량적관계.결과 22례환자중,지유1개파구자15례,파구대소(16±9)mm;≥2개파구자7례,파구대소(6±3)mm.파구위우좌쇄골하동맥이원(B형)16례,파구위우승주동맥(A형)6례.지유1개파구자신혈류량평균위(280±77) ml/(min· 100 ml),A형AD환자신혈류량평균치저우B형[(210±32)ml/(min·100 ml)비(292±43)ml/(min·100 ml),P＜0.01],파구대소여신혈류량고도상관(r=0.968,P=0.000);≥2개파구자신혈류량평균위(246±63)ml/(min·100 ml).수파구수량증다,환자신혈류량평균치승고(P＜0.05),신동맥기원우가강측신관주우우진강측(P＜0.05).결론 AD환자내막파구대소급수목、위치시영향신동맥관주적중요인소.
Objective To investigate the characteristics of renal perfusion in aortic dissection patients using 320 multidetector CT.Methods All 22 aortic dissection patients confirmed by ultrasound underwent 320 multidetector CT renal perfusion (5 ml/s,50 ml,350 mg iodine/ml)before operation.At the same time,we did thoracic and abdominal great vessels CT angiography examination.The renal perfusion and the size,number and position of intimal entries of aortic dissection patients were observed.Results The locations of the intimal entries showed either far from the left subclavian artery (16 patients) or in the ascending aorta(6 patients).Size of entries in 15 patients with only entry was (16 ± 9)mm; the size in 7 patients with entries≥2 was (6 ± 3)mm.The average values of renal blood volume in patients with only entry and entries ≥ 2 were (280± 77)ml/(min · 100 ml) and (246 ±63)ml/(min · 100 ml) respectively.The average blood volumes of patients with type A were less than those of patients with type B [(210 ± 32) ml/(min · 100 ml) vs (292 ± 43) ml/(min · 100 ml),P ＜ 0.01].Among patients with entries≥2,with the increasing number of entries and perfusion of bilateral renal improved(P ＜ 0.05),the average values of patients whose renal artery originated from the false lumen were higher than those whose renal artery came from the true lumen (P ＜ 0.05).Conclusions The size,number and position of intimal entries can influence renal perfusion of patients with aortic dissection.