小儿肾积水血流动力学观察及临床意义

目的:研究小儿肾积水血流动力学指标及其临床意义。方法:应用彩色多普勒超声对20例正常小儿肾脏及30例小儿积水肾进行血流动力学研究。结果:①正常小儿肾脏主肾动脉(MRA)、段动脉(SRA)、叶间动脉(IRA)的血流收缩期峰值速度(PS)、舒张期峰值速度(ED)、平均速度(TAMx)、最低速度(TAMn)依次逐渐减小(P<0.01),MRA、SRA、IRA的阻力指数(RI)无明显改变(P>0.05);积水肾的PS、ED、TAMx、TAMn比正常肾脏的血流速度低(P<0.01),积水肾RI比正常肾RI大(P<0.05)。②肾积水术后1个月RI改善最明显,以后的改善将减缓,而其余各项指标在1~6个月期间恢复最为明显。结论:①肾积水时其血流动力学发生相应的变化,其中RI的变化具有较大临床意义。②梗阻性小儿肾积水,其SRA段RI>0.66。③术后RI值不降或反而升高,提示梗阻未完全解除,需再次手术治疗。

The clinical studies of renal hemodynamics in children with hydronephrosis

Objective: To evaluate renal hemodynamics in children with hydronephrosis. Methods: We evaluated the intrarenal hemodynamics in 30 patients with unilateral or bilateral hydronephrosis and in 20 children with normal kidney using duplex Doppler sonography. Results: Anderson-Hynes procedure were performed in 27 cases and nephrectomy in 3 cases. We found that intrarenal blood velocity decreased gradually(P<0.01), and RI was not changed(P>0.05) among MRA, SRA, and IRA in normal renal units. In patients with hydronephrosis there were significant differences in intrarenal hemodynamics between the 30 patients and 20 normal children(P<0.05). After operation the results of the intrarenal hemodynamics in 30 patients with hydronephrosis return to normal gradually. RI changed most significantly in the first postoperative month. Conclusions: The mean RI values for kidneys of hydronephrosis and normal kidneys were 0.66 and 0.54, respectively. The obstruction may be significant and demands surgical intervention when the RI values reach or more than 0.66. The more severe of obstructive hydronephrosis, the higher RI is, and the less recovery of renal function is. The results can be applied clinically to help justify the indications for surgical intervention and to examine postoperative renal function.