王泽熙 刘帅

【摘要】  目的  探讨肾脏超声在脓毒性休克患儿液体复苏前后肾脏灌注改变的临床特征。方法  以2021年2月- 2022年7月医院收治的脓毒性休克的患儿作为研究对象，将补液试验后床旁超声监测每搏量（stroke volume，SV）增加（△SV）≥12％为容量反应阳性，选取26例容量反应阳性的患儿为阳性组和26例容量反应阴性的患儿为阴性组。监测患儿液体复苏前和复苏6h后肾动脉阻力指数（resistive index， RI）和能量多普勒超声（power doppler ultrasound， PDU）半定量评分。结果  两组患儿在液体复苏前RI值和PDU评分差异均无统计学意义（P>0.05）；液体复苏6h后，两组患儿的RI及PDU评分均明显改善，但阳性组患儿改善程度均优于阴性组患儿，差异具有统计学意义（P<0.05）。结论  肾脏超声可以对脓毒性休克患儿液体复苏前后肾脏灌注情况做出评估，在临床工作中有一定指导作用。

【关键词】  脓毒性休克；液体复苏；肾脏灌注；容量反应性；肾脏超声

中图分类号  R459.7   文献标识码  A    文章编号  1671-0223（2024）13--04

Clinical study of renal perfusion changes by ultrasound in children with septic shock before and afer fluid resuscitation Wang Zexi， Liu Shuai. Hebei Children's Hospital， Shijiazhuang 050031， China

【Abstract】  Objective  Explore the clinical value of renal ultrasound in assessing changes in renal perfusion before and after fluid resuscitation in children with septic shock. Method  Fifty two pediatric patients with septic shock admitted to the hospital from February 2021 to July 2022 were selected as the study subjects. Based on the bedside ultrasound monitoring of whether the increase in stroke volume （SV） （△ SV） ≥ 12% after fluid replacement test， they were divided into volume reaction positive group， volume reaction negative group， and positive group， with 26 cases in each group. Monitor the semi quantitative scores of renal artery resistance index （RI） and power Doppler ultrasound （PDU） before and 6 hours after fluid resuscitation in patients. Results  There was no statistically significant difference in RI and PDU scores between the two groups of patients before fluid resuscitation （P>0.05）; After 6 hours of fluid resuscitation， the RI and PDU scores of children in the volume response positive group were significantly improved compared to those in the volume response negative group， and the difference was statistically significant （P<0.05）. Conclusion  Renal ultrasound can evaluate the renal perfusion before and after fluid resuscitation in children with septic shock， and has a certain guiding role in clinical work.

【Key words】  Septic shock; Fluid resuscitation; Renal perfusion; Volumetric reactivity; Renal ultrasound

脓毒性休克是儿童重病监护病房（PICU）收治的主要疾病之一，其发病率及死亡率高，严重威胁儿童健康[1]。脓毒性休克是脓毒症最严重的症候群，因严重感染继发而导致促炎和抗炎免疫系统激活，这是一种潜在致命的临床疾病，当身体的组织和器官受到感染时，会导致免疫抑制。该病进展快，易合并多器官功能障碍，其中肾脏最常受累。近年来脓毒症急性肾损伤患病率显著增加，儿童脓毒性休克是发生急性肾损伤的危险因素，约有25%～50%的急性肾损伤源于脓毒性休克[2-5]。临床主要是根据尿量及肌酐值来评估肾脏灌注情况，但在疾病发生早期（24h内）无特异性改变，当患者仅出现轻中度肾功能不全时，肌酐对微小的肾小球滤过率降低并不敏感。近年……