床旁重症超声引导的容量管理在急性肾损伤供者维护的应用

Application of bedside critical ultrasound-guided volume management in the maintenance of acute kidney injury donors

    摘要
  • 摘要:
    目的  探讨床旁重症超声在急性肾损伤（AKI）供者容量管理中的应用效果。
    方法 收集广西壮族自治区人民医院移植中心2020年10月1日至2022年5月31日56例AKI供者及对应106例受者的临床资料，根据容量管理方法分为重症超声组（34例供者，66例受者）和传统中心静脉压（CVP）组（22例供者，40例受者），比较分析两组AKI分期和恢复耗时、肾功能指标血清肌酐（Scr）、胱抑素C、估算肾小球滤过率、供肾Remuzzi评分、冷缺血时间、两联升压药使用率及使用时间、移植物功能延迟恢复（DGF）发生率和恢复耗时、术后6个月和12个月肾功能指标等。
    结果  两组供受者性别、年龄、体质量、AKI分期、获取前肾功能指标、两联升压药使用率、术后6个月和12个月肾功能指标、DGF恢复耗时、供肾Remuzzi评分、冷缺血时间差异等均无统计学意义（均为P＞0.05）。重症超声组供者AKI恢复耗时、连续性肾脏替代治疗率、两联升压药使用时间均短于或低于传统CVP组（均为P＜0.05）。重症超声组受者DGF发生率低于传统CVP组（P＜0.05），亚组分析发现，重症超声组受者术后6个月和12个月Scr差异无统计学意义（P＞0.05），而传统CVP组受者术后12个月Scr高于术后6个月（P＜0.05）。
    结论  AKI供肾经过积极维护后可应用于肾移植，床旁重症超声在AKI供者容量管理中具有独特优势，在一定程度上可改善AKI供肾功能。

     

    Abstract:
    Objective  To explore the application effect of bedside critical ultrasound in volume management of acute kidney injury (AKI) donors.
    Methods  Clinical data of 56 AKI donors and 106 recipients from the Transplantation Center of People's Hospital of Guangxi Zhuang Autonomous Region from October 1, 2020 to May 31, 2022 were collected. They were divided into the critical ultrasound group (34 donors, 66 recipients) and the traditional central venous pressure (CVP) group (22 donors, 40 recipients) according to the volume management methods. The AKI stage and recovery time, renal function indicators (serum creatinine (Scr), cystatin C, estimated glomerular filtration rate), donor Remuzzi score, cold ischemia time, biventricular inotrope usage rate and time, delayed graft function (DGF) incidence and recovery time, and renal function indicators at 6 and 12 months after surgery were compared and analyzed between the two groups.
    Results  There were no statistically significant differences in gender, age, body weight, AKI stage, pre-acquisition renal function indicators, biventricular inotrope usage rate, renal function indicators at 6 and 12 months after surgery, DGF recovery time, donor Remuzzi score, and cold ischemia time between the donors and recipients in the two groups (all P>0.05). The AKI recovery time, continuous renal replacement therapy rate and biventricular inotrope usage time of donors in the critical ultrasound group were shorter or lower than those in the traditional CVP group (all P<0.05). The incidence of DGF in recipients of the critical ultrasound group was lower than that of the traditional CVP group (P<0.05). Subgroup analysis showed that there was no statistically significant difference in Scr at 6 and 12 months after surgery in recipients of the critical ultrasound group (P>0.05), while the Scr at 12 months after surgery was higher than that at 6 months in recipients of the traditional CVP group (P<0.05).
    Conclusions  AKI kidneys may be used for kidney transplantation after active maintenance. Bedside critical ultrasound has unique advantages in volume management of AKI donors and may improve the function of AKI kidneys to a certain extent.

     

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