| Objective: To assess the renal perfusion for the critically ill patients with severe craniocerebral injury by using the bedside Doppler ultrasound in the intensive care unit(ICU).To observe the relationship between renal resistive index and serum creatinine,urea nitrogen,urine output,blood lactate and hemodynamics.The survival time of both the operation group and the non-operation group was also compared.The relationship between the changes of renal resistive index and prognosis was further explored.Methods: Fifty-five patients with severe craniocerebral injury admitted in the intensive care unit of Ningbo Second Hospital from March 2016 to January 2017 were enrolled in this study.The acute physiology and chronic disease status score(APACHE ? score)within 24 hours after admission was recorded.During the first week,we continuously measured the variations of bilateral renal resistive index by bedside Doppler ultrasound.The levels of lactate(LAC)in the arterial blood were also measured with a fully automated blood gas analyzer(GEM Premier 3000).The mean arterial pressure(MAP)and central venous pressure(CVP)were used to monitor simultaneously.The survival rates of 7 days,14 days,30 days and 60 days were also tracked.According to the results of head imaging and generalized hemodynamics,we divided the patients into the operation group and the non-operation group,the other physical examination center normal control group 16 cases,as the control group.Results:?28 patients in the operation group,mean bilateral RRI was 0.606±0.038,mean left RRI was 0.607±0.043,mean right RRI was 0.606±0.044.27 patients in the non-operation group,mean bilateral RRI was 0.664±0.049,mean left RRI was 0.666±0.057,mean right RRI was 0.657±0.054.The difference of RRI between the two groups was statistically significant(P<0.05),and the difference between the left and right RRI values was statistically significant(P<0.01).?In the operation group,the mean age was 59.36±13.03 years old,male 75%,APACHE ? score was 18.93±4.46 points,serum creatinine was 79.38±43.14umol/l,urea nitrogen was 8.55±4.40mmol/l,uric acid was 233.74±154.76umol/l,urine output was 4130.57±1678.85ml/d.In the non-operation group,the mean age was 71.67±15.58 years old,male 85.19%,APACHE ? score was 20.33±5.99 points,serum creatinine was 100.76±60.01umol/l,urea nitrogen was 12.64±7.55mmol/l,uric acid was 270.21±187.24umol/l,urine output was 3114.97±1770.87ml/d.There was significant difference in age,serum creatinine,urea nitrogen and urine output between the two groups(P<0.05).There was no significant difference in gender,APACHE ? score and uric acid(P>0.05).?The one-week continuous monitoring of renal resistive in patients with severe craniocerebral injury,RRI increased earlier than serum creatinine,urea nitrogen changes,and reached the peak on the 6th day.?There was no significant difference in the central venous pressure(CVP),mean arterial pressure(MAP),pulse pressure(PP),heart rate(HR),systolic blood pressure(SBP)between the two groups(P>0.05),but the difference of lactate(LAC)and diastolic blood pressure(DBP)was statistically significant(P<0.05).?The correlation analysis shows that the bilateral RRI values of the severe craniocerebral brain injured patients were positively correlated with age,serum creatinine and urea nitrogen,and negatively correlated with diastolic blood pressure,mean arterial pressure and urine output.?The area under the ROC curve of the right,left and bilateral RRI values of the patients with severe craniocerebral injury was 0.710,0.779 and 0.768,respectively.The optimal thresholds of the ROC curve were 0.671,0.648 and 0.622,respectively.The sensitivity and specificity of renal injury were 0.485,0.89;0.727,0.75 and 0.848,0.57.?There was no difference between the two groups of the dosage of noradrenaline and the duration of mechanical ventilation(P>0.05).?The mean survival time of the operation group was 27.89 days,much higher than the non-operation group of 19.48 days.The difference between the two groups was statistically significant(P<0.05).The survival rates of 7 days,14 days and 30 days had no differences(P>0.05).The survival rate of 60 days between the two groups was statistically significant(P<0.05).Conclusion:?Renal resistive index(RRI)can be found early in the presence of acute kidney injury.?Unilateral RRI values were higher than 0.648,with an increased risk of acute kidney injury.?Renal resistive index increased in severe craniocerebral injury patients with non-operation group,survival time is shorter than the operation group of patients,the risk of death was also increased.?Increased renal resistive index can predict the poor prognosis of patients with severe craniocerebral injury,central diabetes insipidus patients need to combine ultrasound Doppler and renal blood flow score to determine the comprehensive analysis. |
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