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| The changes of renal perfusion evaluated by contrast-enhanced ultrasonography on state of intra-abdominal hypertension |
| Sui Feng, Zheng Yue, Ma Wen-liang, Huang Li-feng, Li Wen-xiong, Cao Wen |
| Department of Surgical Intensive Care Unit, Beijing Chao-yang Hospital, Capital Medical University, Beijing 100020, China |
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Abstract Objective Intranet-abdominal hypertension(IAH) and abdominal compartment syndrome (ACS) are common complications in trauma and surgical intensive care unit. The increasing abdominal pressure can cause the decrease of blood perfusion of kidney and renal injury. To evaluate the change of renal blood perfusion by the examination of contrast-enhanced ultrasonography (CEUS) in intra-abdominal hypertension porcian model. Methods In 12 pigs, IAP was increased stepwise to 10, 15, 20, 25 mm Hg while hemodynamic parameters, urinary output, renal contrast enhanced ultrasound (CEUS) and LDPI pictures were all recorded. Results With IAP elevated to 25 mm Hg gradually, compared to the baseline, the piglets showed markedly longer wash in time (WIT) and time to peak (TTP)(P<0.05), but significantly declines of peak intensity (PI), wash in slope (WIS) and area under curve (AUC)(P<0.05) in CEUS. With the increasing of abdominal pressure the perfusion unit was significantly decreased. PI showed a moderate correlation with PU (r＝0.83, P<0.05) and AUC showed negative correlation with PU. Conclusion CEUS is a safe, real-time dynamic, noninvasive and simple technique to evaluate renal microvascular perfusion in IAH state. PI and AUC could be used for the diagnosis of the renal microvascular damage in a porcine model of IAP-induced renal impairment. LDPI is a very useful tool to evaluate the change of microcirculation.
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Corresponding Authors:
Cao Wen, E-mail: caowenemail@126.com
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| ［1］Vidal MG, Ruiz Weisser J, Gonzalez F, et al. Incidence and clinical effects of intra-abdominal hypertension in critically ill patients［J］. Crit Care Med, 2008, 36(6):1823-1831.
［2］邹鑫森, 张可祥, 崔勇, 等. CRRT 联合腹腔引流对重症胰腺炎合并 IAH/ACS的影响研究［J］. 中国急救医学, 2015, 35(10):883-887.
［3］Kim IB, Prowle J, Baldwin I, et al. Incidence, risk factors and outcome associations of intra-abdominal hypertension in critically ill patients［J］. Anaesth Intensive Care， 2012， 40(1):79-89.
［4］Rezende-Neto JB, Moore EE, Melo de Andrade MV, et al. Systemic inflammatory response secondary to abdominal compartment syndrome: stage for multiple organ failure［J］. J Trauma， 2002，53(6):1121-1128.
［5］De Waele JJ, De Laet I. Intra-abdominal hypertension and the effect on renal function［J］. Acta Clin Belg， 2007， 62(Suppl 2):371-374.
［6］Malbrain ML, De Laet IE, De Waele JJ, et al. Intra-abdominal hypertension: definitions, monitoring, interpretation and management［J］. Best Pract Res Clin Anaesthesiol, 2013, 27(2):249-270.
［7］Toens C, Schachtrupp A, Hoer J, et al. A porcine model of the abdominal compartment syndrome［J］. Shock， 2002， 18(4):316-321.
［8］孙薇, 罗高兴, 吴军. 激光多普勒技术在烧伤创面深度及愈合时间评价中的应用进展［J］. 中华烧伤杂志， 2011， 27(4):287-290.
［9］Brabrand K, de Lange C, Emblem KE, et al. Contrast-enhanced ultrasound identifies reduced overall and regional renal perfusion during global hypoxia in piglets［J］. Invest Radiol， 2014， 49(8):540-546.
［10］Sui F, Zheng Y, Li WX, et al. Renal circulation and microcirculation during intra-abdominal hypertension in a porcine model［J］. Eur Rev Med Pharmacol Sci, 2016， 20(3):452-461.
［11］Schneider AG, Goodwin MD, Schelleman A, et al. Contrast-enhanced ultrasound to evaluate changes in renal cortical perfusion around cardiac surgery: a pilot study［J］. Crit Care， 2013， 17(4):R138.
［12］Min S, Lee H, Kim SY, et al. Local changes in microcirculation and the analgesic effects of acupuncture: a laser Doppler perfusion imaging study［J］. J Altern Complement Med, 2015， 21(1):46-52.
［13］隋峰, 郑悦, 马文良, 等. 腹腔高压致肾脏和全身微循环变化的实验研究［J］. 中国急救医学， 2017， 37(1):81-86.
［14］Bloomfield GL, Blocher CR, Fakhry IF, et al. Elevated intra-abdominal pressure increases plasma renin activity and aldosterone levels［J］. J Trauma, 1997， 42(6):997-1004.
［15］Mohmand H, Goldfarb S. Renal dysfunction associated with intra-abdominal hypertension and the abdominal compartment syndrome［J］. J Am Soc Nephrol, 2011， 22(4):615-621.
［16］Ma F, Cang Y, Zhao B, et al. Contrast-enhanced ultrasound with SonoVue could accurately assess the renal microvascular perfusion in diabetic kidney damage［J］. Nephrol Dial Transplant， 2012， 27(7):2891-2898.
［17］Doty JM, Saggi BH, Blocher CR, et al. Effects of increased renal parenchymal pressure on renal function［J］. J Trauma， 2000， 48(5):874-877. |
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