肾阻力指数在脓毒症所致急性肾损伤中的研究进展
Research Progress of Renal Resistance Index in Acute Renal Injury Caused by Sepsis
DOI: 10.12677/ACM.2023.13112568, PDF,   
作者: 李慧婷:青海大学研究生院,青海 西宁 ;童世君*:青海大学附属医院重症医学科,青海 西宁
关键词: 脓毒症急性肾损伤肾阻力指数Sepsis Acute Kidney Injury Renal Resistance Index
摘要: 脓毒症临床常见的危重病,发病率高,病死率高,严重威胁人们生命。其中,肾脏是脓毒症最常累及的器官之一,脓毒症所致急性肾伤(S-AKI)与患者不良预后相关,目前S-AKI的诊断主要依靠指南上的尿量和肌酐,但尿量和肌酐受多种因素的影响,确诊时间延迟且价值不高。随着超声技术的发展,床旁超声在严重肾脏疾病方面中的应用越来越广泛,基于多普勒的肾阻力指数(RRI)是肾脏检查中描述最多的测量值,具有无创、安全、可重复操作等优点,是S-AKI床旁诊断的重要工具。本文主要从RRI的定义、测量方法、影响因素及其早期诊断S-AKI的临床意义进行综述。
Abstract: Sepsis is a common critical illness with high morbidity and fatality rate, which seriously threatens people’s lives. Among them, kidney is one of the most commonly involved organs of sepsis, acute renal injury (S-AKI) caused by sepsis is associated with poor prognosis of patients. Currently, the diagnosis of S-AKI mainly relies on urine volume and creatinine as shown in the guidelines, but urine volume and creatinine are affected by various factors, so the diagnosis time is delayed and the value is not high. With the development of ultrasound technology, bedside ultrasound has been ap-plied more and more widely in severe kidney diseases. The renal resistance index (RRI) based on Doppler is the most described measurement value in kidney examination, which has the ad-vantages of non-invasive, safe and repeatable operation, and is an important tool for S-AKI bedside diagnosis. This article mainly reviews the definition, measurement method, influencing factors of RRI and its clinical significance in early diagnosis of S-AKI.
文章引用:李慧婷, 童世君. 肾阻力指数在脓毒症所致急性肾损伤中的研究进展[J]. 临床医学进展, 2023, 13(11): 18296-18300. https://doi.org/10.12677/ACM.2023.13112568

参考文献

[1] Evans, L., Rhodes, A., Alhazzani, W., et al. (2021) Surviving Sepsis Campaign: International Guidelines for Manage-ment of Sepsis and Septic Shock 2021. Intensive Care Medicine, 47, 1181-1247. [Google Scholar] [CrossRef] [PubMed]
[2] Poston, J.T. and Koyner, J.L. (2019) Sepsis Associated Acute Kidney Injury. BMJ (Clinical Research ed), 364, k4891. [Google Scholar] [CrossRef] [PubMed]
[3] Hsu, Y.C. and Hsu, C.W. (2019) Septic Acute Kidney Injury Patients in Emergency Department: The Risk Factors and Its Correlation to Serum Lactate. The American Journal of Emergency Medicine, 37, 204-208. [Google Scholar] [CrossRef] [PubMed]
[4] Bagshaw, S.M., George, C. and Bellomo, R. (2008) Early Acute Kidney Injury and Sepsis: A Multicentre Evaluation. Critical Care (London, England), 12, R47. [Google Scholar] [CrossRef] [PubMed]
[5] See, E.J., Jayasinghe, K., Glassford, N., et al. (2019) Long-Term Risk of Ad-verse Outcomes after Acute Kidney Injury: A Systematic Review and Meta-Analysis of Cohort Studies Using Consensus Definitions of Exposure. Kidney International, 95, 160-172. [Google Scholar] [CrossRef] [PubMed]
[6] Xu, X., Nie, S., Liu, Z., et al. (2015) Epidemiology and Clinical Correlates of AKI in Chinese Hospitalized Adults. Clinical Journal of the American Society of Nephrology: CJASN, 10, 1510-1518. [Google Scholar] [CrossRef
[7] Khwaja, A. (2012) KDIGO Clinical Practice Guidelines for Acute Kidney Injury. Nephron Clinical Practice, 120, c179-c184. [Google Scholar] [CrossRef] [PubMed]
[8] Peerapornratana, S., Manrique-Caballero, C.L., Gómez, H., et al. (2019) Acute Kidney Injury from Sepsis: Current Concepts, Epidemiology, Pathophysiology, Prevention and Treatment. Kidney International, 96, 1083-1099. [Google Scholar] [CrossRef] [PubMed]
[9] Kellum, J.A., Sileanu, F.E., Murugan, R., et al. (2015) Classifying AKI by Urine Output versus Serum Creatinine Level. Journal of the American Society of Nephrology: JASN, 26, 2231-2238. [Google Scholar] [CrossRef
[10] Keogan, M.T., Kliewer, M.A., Hertzberg, B.S., et al. (1996) Renal Resistive Indexes: Variability in Doppler US Measurement in a Healthy Population. Radiology, 199, 165-169. [Google Scholar] [CrossRef] [PubMed]
[11] Tublin, M.E., Bude, R.O. and Platt, J.F. (2003) Review. The Resistive Index in Renal Doppler Sonography: Where Do We Stand? AJR American Journal of Roentgen-ology, 180, 885-892. [Google Scholar] [CrossRef] [PubMed]
[12] Schnell, D. and Darmon, M. (2012) Renal Doppler to Assess Renal Perfusion in the Critically Ill: A Reappraisal. Intensive Care Medicine, 38, 1751-1760. [Google Scholar] [CrossRef] [PubMed]
[13] Murat, A., Akarsu, S., Ozdemir, H., et al. (2005) Renal Resistive Index in Healthy Children. European Journal of Radiology, 53, 67-71. [Google Scholar] [CrossRef] [PubMed]
[14] Ponte, B., Pruijm, M., Ackermann, D., et al. (2014) Reference Values and Factors Associated with Renal Resistive Index in a Family-Based Population Study. Hypertension (Dallas, Tex: 1979), 63, 136-142. [Google Scholar] [CrossRef
[15] Murphy, M.E. and Tublin, M.E. (2000) Under-standing the Doppler RI: Impact of Renal Arterial Distensibility on the RI in a Hydronephrotic ex Vivo Rabbit Kidney Model. Journal of Ultrasound in Medicine: Official Journal of the American Institute of Ultrasound in Medicine, 19, 303-314. [Google Scholar] [CrossRef] [PubMed]
[16] Tublin, M.E., Tessler, F.N. and Murphy, M.E. (1999) Correlation between Renal Vascular Resistance, Pulse Pressure, and the Resistive Index in Isolated Perfused Rabbit Kid-neys. Radiology, 213, 258-264. [Google Scholar] [CrossRef] [PubMed]
[17] O’neill, W.C. (2014) Renal Resistive Index: A Case of Mistaken Identity. Hypertension (Dallas, Tex: 1979), 64, 915-917. [Google Scholar] [CrossRef
[18] Bude, R.O. and Rubin, J.M. (1999) Relationship between the Resistive Index and Vascular Compliance and Resistance. Radiology, 211, 411-417. [Google Scholar] [CrossRef] [PubMed]
[19] Berni, A., Ciani, E., Bernetti, M., et al. (2012) Renal Re-sistive Index and Low-Grade Inflammation in Patients with Essential Hypertension. Journal of Human Hypertension, 26, 723-730. [Google Scholar] [CrossRef] [PubMed]
[20] Manrique-Caballero, C.L., Del Rio-Pertuz, G., Gomez, H. (2021) Sepsis-Associated Acute Kidney Injury. Critical Care Clinics, 37, 279-301. [Google Scholar] [CrossRef] [PubMed]
[21] Daher, E.F., Marques, C.N., Lima, R.S., et al. (2008) Acute Kidney Injury in an Infectious Disease Intensive Care Unit—An Assessment of Prognostic Factors. Swiss Medical Weekly, 138, 128-133. [Google Scholar] [CrossRef] [PubMed]
[22] Shum, H.P., Kong, H.H., Chan, K.C., et al. (2016) Septic Acute Kidney Injury in Critically Ill Patients—A Single-Center Study on Its Incidence, Clinical Characteristics, and Outcome Predictors. Renal Failure, 38, 706-716. [Google Scholar] [CrossRef
[23] Lerolle, N., Guérot, E., Faisy, C., et al. (2006) Renal Failure in Septic Shock: Predictive Value of Doppler-Based Renal Arterial Resistive Index. Intensive Care Medicine, 32, 1553-1559. [Google Scholar] [CrossRef] [PubMed]
[24] Darmon, M., Schortgen, F., Vargas, F., et al. (2011) Diagnostic Accuracy of Doppler Renal Resistive Index for Reversibility of Acute Kidney Injury in Critically Ill Patients. Intensive Care Medicine, 37, 68-76. [Google Scholar] [CrossRef] [PubMed]
[25] Haitsma Mulier, J.L.G., Rozemeijer, S., Röttgering, J.G., et al. (2018) Renal Resistive Index as an Early Predictor and Discriminator of Acute Kidney Injury in Critically Ill Patients; a Prospective Observational Cohort Study. PLOS ONE, 13, e0197967. [Google Scholar] [CrossRef] [PubMed]
[26] Xing, Z.Q., Liu, D.W., Wang, X.T., et al. (2019) The Value of Renal Resistance Index and Urine Oxygen Pressure for Prediction of Acute Kidney Injury in Patients with Septic Shock. Chinese Journal of Internal Medicine, 58, 349-354.