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IntroductionLeabharlann Baidu
• Fluid resuscitation is a first-line therapy used to restore oxygen delivery to the organs and prevent AKI and yet the renal effects of fluid resuscitation are not easily assessed.
Introduction
• Acute kidney injury (AKI) is a frequent complication of circulatory failure and associated with increased morbidity and mortality .
• 急性肾损伤是循环衰竭状态下的常见并发症，它与发 病率及死亡率的升高密切相关。
oxygen demand
oxygen delivery
Imbalance in oxygen delivery and oxygen demand is common in critically ill patients, especially those with acute circulatory failure of septic, hypovolemic or cardiogenic origin.
Fig. 2 Study Consort diagram. *Six patients had two Doppler waves instead of three or more, two patients had >5 % difference in RI between the kidneys. RIAD renal interlobar artery Doppler.
• 医师通常通过全身血流动力学变量来评估液体治疗的效果，比 如：平均动脉压、心输出量，因为尿量增加可能会延迟或者与 实际情况不一致，血肌酐的下降也非常慢，这些指标都不能及 时有效的反应肾灌注情况。
• 一种可以直接评估肾脏血流动力学的方法将非常有价值。
Introduction
• We used Doppler techniques to investigate the effects of fluid administration on intrarenal hemodynamics and the relationship between changes in renal hemodynamics and urine output.
Effects of fluid administration on renal perfusion in critically ill patients
危重病人液体管理对肾灌注的影响
Contents
1
Introduction
2
Methods
3
Results
4
Conclusions
InDtrioadgucrtaiomn
肾脏血管的测量和正常值
阻力指数（RI，Resistance Index ）= （Vmax-Vmin）/ Vmax
正常肾各段肾动脉的阻力指数（RI）
各段肾动脉RI
主肾动脉
段动脉
叶间动脉 弓状动脉 小叶间动脉
0.650.02 0.630.04 0.590.02 0.54 0.03 0.510.04
Criteria--Control group
The control groups included ICU patients with stable systemic hemodynamics receiving no specific intervention. 对照组包括全身血流动力学稳定且没有接受特殊干预的ICU病人。
• 我们用多普勒技术研究液体管理对肾内血流动力学的影响以及 肾脏血流动力学与尿量的关系。
Fig. 1 Summary of the study design. The intervention was a fluid challenge that consisted of infusion of a minimum volume of 500 ml at a minimum rate of 1,000 ml/hour. Interlobar artery Doppler variables, blood pressure, heart rate and urine output were recorded before and after the fluid challenge and stabilization of hemodynamic variables. UO/3H: urine output volumes measured over 3 hours.
Control group A
评价观察者在测量肾叶间动脉RI自身偏差 ——测量3次（3个心动周期），每次间隔15min 同一超声医师测量，RI计算由统计员负责。
• 液体复苏是恢复器官血氧输送及预防AKI的一线治 疗方法，然而液体复苏对于肾脏的影响是不容易评 估的。
Introduction
• Physicians generally evaluate the effectiveness of fluid therapy by looking at systemic hemodynamic variables, such as mean arterial pressure (MAP) or cardiac output, because the increase in urine output may be delayed or inconsistent and the decrease in serum creatinine may be even slower. A direct evaluation of renal hemodynamics would be valuable.