Contrast-enhanced ultrasonography to evaluate changes in renal cortical microcirculation induced by noradrenaline: a pilot study.
Contrast-enhanced ultrasonography to evaluate changes in renal cortical microcirculation induced by noradrenaline: a pilot study.
复制标题
对比增强的超声检查，以评估去甲肾上腺素引起的肾皮质微循环的变化：一项初步研究。
DOI：
10.1186/s13054-014-0653-3
复制
发表时间：
2014-12-02
期刊：
影响因子：
--
通讯作者：
Bellomo R
中科院分区：
文献类型：
--
作者：
Schneider AG;Goodwin MD;Schelleman A;Bailey M;Johnson L;Bellomo R
我们采用超声造影（CEUS）来评估输注去甲肾上腺素引起的平均动脉压（MAP）升高对危重患者肾微血管皮质灌注的影响。该研究纳入了12例需要输注去甲肾上腺素以在重症监护室入院48小时内维持MAP大于60 mmHg的患者。在基线（MAP 60 - 65 mmHg）和去甲肾上腺素诱导的MAP升高至80 - 85 mmHg后，使用破坏-补充序列和Sonovue®（Bracco，意大利米兰）作为造影剂进行肾脏超声造影扫描。超声造影剂的使用或去甲肾上腺素输注速率的增加均无不良反应。在所有研究时间，所有患者都获得了足够的图像。为了达到较高的MAP目标，去甲肾上腺素中位输注速率从10 μg/min增加到14 μg/min。去甲肾上腺素诱导的MAP升高与总体CEUS平均灌注指数的显著变化无关（基线时灌注指数中位数为3056（四分位数范围：2438至6771）任意单位（a.u），而MAP升高后为4101(3067至5981)a.u, P = 0.38）。然而，在个体水平上，我们观察到反应的重要异质性（从基线变化范围为-51%至+97%）。去甲肾上腺素诱导的MAP增加与超声造影估计的肾皮质灌注总体增加无关。然而，在个体水平上，这种反应是异质的和不可预测的，这表明在具有相似临床表型的队列中，压力反应性存在很大差异。本文的在线版本（doi:10.1186/s13054-014-0653-3）包含补充材料，仅供授权用户使用。
We used contrast-enhanced ultrasound (CEUS) to estimate the effect of an increase in mean arterial pressure (MAP) induced by noradrenaline infusion on renal microvascular cortical perfusion in critically ill patients. Twelve patients requiring a noradrenaline infusion to maintain a MAP more than 60 mmHg within 48 hours of intensive care unit admission were included in the study. Renal CEUS scans with destruction-replenishment sequences and Sonovue® (Bracco, Milano Italy) as a contrast agent, were performed at baseline (MAP 60 to 65 mmHg) and after a noradrenaline-induced increase in MAP to 80 to 85 mmHg. There was no adverse effect associated with ultrasound contrast agent administration or increase in noradrenaline infusion rate. Adequate images were obtained in all patients at all study times. To reach the higher MAP target, median noradrenaline infusion rate was increased from 10 to 14 μg/min. Noradrenaline-induced increases in MAP were not associated with a significant change in overall CEUS derived mean perfusion indices (median perfusion index 3056 (interquartile range: 2438 to 6771) arbitrary units (a.u.) at baseline versus 4101 (3067 to 5981) a.u. after MAP increase, P = 0.38). At individual level, however, we observed important heterogeneity in responses (range -51% to +97% changes from baseline). A noradrenaline-induced increase in MAP was not associated with an overall increase in renal cortical perfusion as estimated by CEUS. However, at individual level, such response was heterogeneous and unpredictable suggesting great variability in pressure responsiveness within a cohort with a similar clinical phenotype. The online version of this article (doi:10.1186/s13054-014-0653-3) contains supplementary material, which is available to authorized users.
登录
查看更多内容
幸存的败血症运动：严重败血症和化粪池冲击管理的国际指南，2012年。
影响因子：
38.9
作者：
Dellinger RP;Levy MM;Rhodes A;Annane D;Gerlach H;Opal SM;Sevransky JE;Sprung CL;Douglas IS;Jaeschke R;Osborn TM;Nunnally ME;Townsend SR;Reinhart K;Kleinpell RM;Angus DC;Deutschman CS;Machado FR;Rubenfeld GD;Webb S;Beale RJ;Vincent JL;Moreno R;Surviving Sepsis Campaign Guidelines Committee including The Pediatric Subgroup
通讯作者：
Surviving Sepsis Campaign Guidelines Committee including The Pediatric Subgroup
DOI：
10.1186/cc12818
发表时间：
2013-07-12
期刊：
Critical care (London, England)
影响因子：
--
作者：
Burban M;Hamel JF;Tabka M;de La Bourdonnaye MR;Duveau A;Mercat A;Calès P;Asfar P;Lerolle N
通讯作者：
Lerolle N
影响因子：
6.1
作者：
Schneider, Antoine G.;Hofmann, Lucie;Vogt, Bruno
通讯作者：
Vogt, Bruno
影响因子：
5.4
作者：
Kishimoto, N;Mori, Y;Iwasaka, T
通讯作者：
Iwasaka, T
DOI：
10.1152/ajprenal.00727.2009
发表时间：
2010-10-01
影响因子：
4.2
作者：
Hill, J. V.;Findon, G.;Endre, Z. H.
通讯作者：
Endre, Z. H.