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1、Effectsoffluidadministrationonrenalperfusionincriticallyillpatients危重病人液体管理对肾灌注的影响ContentsIntroduction1Methods2Results3Conclusions4DiagramoxygendeliveryoxygendemandImbalanceIntroductionImbalanceinoxygendeliveryandoxygendemandiscommonincriticallyillpatients,especiallythosewithacutecirculatoryfailur

2、eofseptic,hypovolemicorcardiogenicorigin.IntroductionAcutekidneyinjury(AKI)isafrequentcomplicationofcirculatoryfailureandassociatedwithincreasedmorbidityandmortality.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。IntroductionFluidresuscitationisafirst-linetherapyusedtorestoreoxygendeliverytotheorgansandprev

3、entAKIandyettherenaleffectsoffluidresuscitationarenoteasilyassessed.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。IntroductionPhysiciansgenerallyevaluatetheeffectivenessoffluidtherapybylookingatsystemichemodynamicvariables,suchasmeanarterialpressure(MAP)orcardiacoutput,becausetheincreaseinurineo

4、utputmaybedelayedorinconsistentandthedecreaseinserumcreatininemaybeevenslower.Adirectevaluationofrenalhemodynamicswouldbevaluable.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。IntroductionWeusedDopplertechniquestoinvestigateth

5、eeffectsoffluidadministrationonintrarenalhemodynamicsandtherelationshipbetweenchangesinrenalhemodynamicsandurineoutput.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.1Summaryofthestudydesign.Theinterventionwasafluidchallengethatconsistedofinfusionofaminimumvolumeof500mlataminimumrateof1,000ml/hour.I

6、nterlobararteryDopplervariables,bloodpressure,heartrateandurineoutputwererecordedbeforeandafterthefluidchallengeandstabilizationofhemodynamicvariables.UO/3H:urineoutputvolumesmeasuredover3hours.肾脏血管的测量和正常值阻力指数（RI，ResistanceIndex）=（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0.650.0

7、20.630.040.590.020.540.030.510.04Fig.2StudyConsortdiagram.*SixpatientshadtwoDopplerwavesinsteadofthreeormore,twopatientshad>5%differenceinRIbetweenthekidneys.RIADrenalinterlobararteryDoppler.Criteria--Control