CAJ | 학술논문

目的探讨感染性休克患者入ICU早期全身血流动力学与肾血流评分及肾动脉阻力指数的关系.方法前瞻性观察感染性休克患者,在入室早期复苏阶段(1、6 h)分别进行心脏超声、肾脏超声检查,同时记录患者的平均动脉压(MAP)、中心静脉压(CVP)、心输出量(CO),肾血流评分及肾动脉阻力指数(RI).结果共收入北京协和医院重症医学科患者39例.根据复苏后CVP的变化,分为CVP不升组和CVP上升组.CVP不升组19例患者中,MAP、CO均上升患者8例,其他患者11例,MAP、CO均上升患者中有6例肾血流评分上升,其他患者只有1例肾血流评分上升(P=0.027).CVP上升组20例患者中,MAP、CO均未上升患者9例,其他患者11例,MAP、CO均未上升患者中有8例肾血流评分下降,其他患者只有2例肾血流评分下降(P=0.086).CVP不升组患者复苏前后RI差异无统计学意义,且MAP、CO均上升患者与其他患者相比,复苏前、复苏后RI均差异无统计学意义;CVP上升组患者复苏前后RI差异无统计学意义,且MAP、CO均未上升患者与其他患者相比,复苏前、复苏后RI均差异无统计学意义;分别按MAP及CO是否上升分组,各组复苏前后阻力指数均差异无统计学意义.结论感染性休克入ICU早期复苏时细化的肾血流评分在中心静脉压无明显上升时,随CO、MAP的上升而升高.肾动脉RI与CO、MAP及CVP无明显相关性,不宜作为判断感染性休克早期患者肾脏灌注的指标.
목적 탐토감염성휴극환자입ICU조기전신혈류동역학여신혈류평분급신동맥조력지수적관계.방법 전첨성관찰감염성휴극환자,재입실조기복소계단(1、6 h)분별진행심장초성、신장초성검사,동시기록환자적평균동맥압(MAP)、중심정맥압(CVP)、심수출량(CO),신혈류평분급신동맥조력지수(RI).결과 공수입북경협화의원중증의학과환자39례.근거복소후CVP적변화,분위CVP불승조화CVP상승조.CVP불승조19례환자중,MAP、CO균상승환자8례,기타환자11례,MAP、CO균상승환자중유6례신혈류평분상승,기타환자지유1례신혈류평분상승(P=0.027).CVP상승조20례환자중,MAP、CO균미상승환자9례,기타환자11례,MAP、CO균미상승환자중유8례신혈류평분하강,기타환자지유2례신혈류평분하강(P=0.086).CVP불승조환자복소전후RI차이무통계학의의,차MAP、CO균상승환자여기타환자상비,복소전、복소후RI균차이무통계학의의;CVP상승조환자복소전후RI차이무통계학의의,차MAP、CO균미상승환자여기타환자상비,복소전、복소후RI균차이무통계학의의;분별안MAP급CO시부상승분조,각조복소전후조력지수균차이무통계학의의.결론 감염성휴극입ICU조기복소시세화적신혈류평분재중심정맥압무명현상승시,수CO、MAP적상승이승고.신동맥RI여CO、MAP급CVP무명현상관성,불의작위판단감염성휴극조기환자신장관주적지표.
Objective To assess the variations of renal vascularization scale and resistive index in septic shock patients during the first 6 h in intensive care unit (ICU).Methods A total of 39 septic shock patients were prospectively enrolled to receive echocardiographic and renal ultrasound examinations.And the data of mean arterial pressure (MAP),central venous pressure (CVP),cardiac output (CO),renal vascularization scale (VS) and resistive index (RI) were recorded.Results Among 19 patients without an increase of CVP,8 of them showed significant increase in MAP and CO.Six of 8 patients with increases both in MAP and CO displayed an increase of VS while only 1 out of the remaining 11 patients had an increase of VS (P =0.027).Among 20 patients with an increase of CVP,9 of them showed no significant increase in MAP or CO.Eight out of 9 patients without significant increase in MAP or CO displayed a decrease of VS while only 2 out of the remaining 11 patients displayed a decrease of VS (P =0.086).They were divided into two groups according to the variations of MAP,CVP and CO respectively.No significant change of RI was found between oh and 6 h in each group.Conclusion The renal vascularization scale increases in patients with increases both in CO and MAP while CVP remains almost unchanged.No significant relationship exists between resistive index and such hemodynamic parameters as CO,MAP and CVP.