英文文献报告PPT模板

Effectsoffluidadministrationonrenalperfusionincriticallyillpatients危重病人液体管理对肾灌注的影响,Contents,Diagram,oxygendelivery,oxygendemand,Imbalance,Introduction,Imbalanceinoxygendeliveryandoxygendemandiscommonincriticallyillpatients,especiallythosewithacutecirculatoryfailureofseptic,hypovolemicorcardiogenicorigin.,Introduction,Acutekidneyinjury(AKI)isafrequentcomplicationofcirculatoryfailureandassociatedwithincreasedmorbidityandmortality.急性肾损伤是循环衰竭状态下的常见并发症，它与发病率及死亡率的升高密切相关。,Introduction,Fluidresuscitationisafirst-linetherapyusedtorestoreoxygendeliverytotheorgansandpreventAKIandyettherenaleffectsoffluidresuscitationarenoteasilyassessed.液体复苏是恢复器官血氧输送及预防AKI的一线治疗方法，然而液体复苏对于肾脏的影响是不容易评估的。,Introduction,Physiciansgenerallyevaluatetheeffectivenessoffluidtherapybylookingatsystemichemodynamicvariables,suchasmeanarterialpressure(MAP)orcardiacoutput,becausetheincreaseinurineoutputmaybedelayedorinconsistentandthedecreaseinserumcreatininemaybeevenslower.Adirectevaluationofrenalhemodynamicswouldbevaluable.医师通常通过全身血流动力学变量来评估液体治疗的效果，比如：平均动脉压、心输出量，因为尿量增加可能会延迟或者与实际情况不一致，血肌酐的下降也非常慢，这些指标都不能及时有效的反应肾灌注情况。一种可以直接评估肾脏血流动力学的方法将非常有价值。,Introduction,WeusedDopplertechniquestoinvestigatetheeffectsoffluidadministrationonintrarenalhemodynamicsandtherelationshipbetweenchangesinrenalhemodynamicsandurineoutput.我们用多普勒技术研究液体管理对肾内血流动力学的影响以及肾脏血流动力学与尿量的关系。,Fig.1Summaryofthestudydesign.Theinterventionwasafluidchallengethatconsistedofinfusionofaminimumvolumeof500mlataminimumrateof1,000ml/hour.InterlobararteryDopplervariables,bloodpressure,heartrateandurineoutputwererecordedbeforeandafterthefluidchallengeandstabilizationofhemodynamicvariables.UO/3H:urineoutputvolumesmeasuredover3hours.,肾脏血管的测量和正常值,正常肾各段肾动脉的阻力指数（RI）,各段肾动脉RI,主肾动脉段动脉叶间动脉弓状动脉小叶间动脉,0.650.020.630.040.590.020.540.030.510.04,Fig.2StudyConsortdiagram.*SixpatientshadtwoDopplerwavesinsteadofthreeormore,twopatientshad5%differenceinRIbetweenthekidneys.RIADrenalinterlobararteryDoppler.,Criteria-Controlgroup,ThecontrolgroupsincludedICUpatientswithstablesystemichemodynamicsreceivingnospecificintervention.对照组包括全身血流动力学稳定且没有接受特殊干预的ICU病人。,ControlgroupA,评价观察者在测量肾叶间动脉RI自身偏差测量3次（3个心动周期），每次间隔15min同一超声医师测量，RI计算由统计员负责。,ControlgroupB,评价多普勒变量的稳定性测量2次，间隔60min由同一超声医师测量，RI计算由统计员负责。,Criteria-Interventiongroup,需要液体冲击治疗的急性循环衰竭患者：并且至少包含以下一条标准：,神志改变四肢白斑动脉血乳酸2mmol/LScvO270%或SvO265%,低动脉压：收缩期动脉压90mmHgorMAP65mmHg需要升压药纠正低血压少尿（尿量65mmHg,MAPstrokevolumeincrease10-15%基础值,CVP15mmHg,Results,Results,FluidadministrationresultedinincreasesinMAPfrom7515to8014mmHg(p0.01)PPfrom4919to5519mmHg(p0.01).RIdecreasedconcurrentlyfrom0.730.09to0.710.09(p0.01)urineoutputincreasedfrom5576to8187ml/hour(p0.01).,Results,Fig.4Changesinhemodynamicvariablesbeforeandafterfluidchallenge.AChangesinresistivityindex(RI).BChangesinmeanarterialpressure(MAP)andinpulsepressure(PP).They-axesshowthemeanvaluesstandarddeviation.MAP1,PP1,RI1arevaluesbeforefluidchallengeandMAP2,PP2,RI2arevaluesafterfluidchallenge.,Atbaseline,RIpredictedanincreaseinurineoutputfollowingafluidchallengeatallthresholdsandMAPpredictedanincreaseatthresholdsof0.2ml/kg/hourand0.3ml/kg/hour,butnot0.1ml/kg/hour(Table3).,Conclusions,WeshowedthatfluidadministrationreducesintrarenalvasoconstrictionandthatchangesinRIaremoreeffectivethanchangesinMAPandPPtopredictanincreaseinurineoutputafterfluidchallenge.DynamicanalysisofintrarenalhemodynamicsusingRIADcanidentifyrenalresponsivepatients.However,theuseofRItoguidefluidtherapyforrenalhemodynamicmanagementmaybelimitedbythesmallma