食道超声评价儿童及婴幼儿体外循环下肾脏血流量与体外循环灌注流量关系的临床研究

目的 探索食道超声(TEE)在儿童及婴幼儿心脏手术围术期多时点动态监测肾脏血流的可行性,观察体外循环下影响肾脏灌注的因素。 方法 纳入因先天性心脏病行体外循环下手术的患儿,使用TEE测量左肾动脉直径和血流速度并计算肾脏血流量。记录体外循环参数、血流动力学指标。分析肾脏血流量与体外循环流量及平均动脉压力的关系。 结果 纳入的46例患儿中有42例获得满意的肾动脉血流图像,成功率91%。患儿体外循环后肾动脉阻力指数显著高于体外循环前。肾血流平均流速及肾血流量与体外循环流量呈直线相关,与平均动脉压的线性关系无统计学意义。 结论 儿童及婴幼儿心脏手术体外循环期间,体外循环灌注流量是决定其肾血流灌注的主要因素。对该类患者,TEE肾脏灌注监测可作为一种体外循环中实时动态的肾脏灌注监测手段。

Using Trans-esophageal Echocardiogram to Evaluate the Relationship Between Renal Blood Flow and Cardiopulmonary Bypass Perfusion Volume in Pediatric and Infant Patients

Objective To evaluate the feasibility of using trans-esophageal echocardiogram (TEE) in dynamic monitoring of renal blood flow (RBF) in pediatric patient undergoing cardiac surgery and to identify potential factors that affect RBF during cardiopulmonary bypass (CPB). Methods Pediatric patient (n=46) undergoing open surgical repair for congenital heart defect were recruited in this study. Velocity of RBF and renal artery diameter were measured during surgery for calculating volumetric RBF. Cardiopulmonary bypass and hemodynamic data were recorded. Results RBF was measured successfully in 42 patients (91%). Resistance index of renal artery increased significantly after CPB compared to the preoperative stage. A strong linear correlation was found between perfusion volume (V_mean) and RBF. Non-linear correlation was found between mean arterial pressure and RBF. Conclusion Perfusion volume is the major factor that determines RBF during CPB. Measuring renal blood flow using TEE in pediatric patient is highly feasible and it can serve as dynamic renal perfusion monitoring during CPB.