| Objective:To explore the reliability of the application of bedside ultrasound in intensive care unit to assess the function of Cardiovascular and renal,then verify that it is helpful for physician to diagnosis and treatment disease earlier.Methods:This is a prospective,observational,single-center study including 54 patients who need PiCCO monitor to test cardiac-pulmonary function from November 2016 to March 2017 in ICU of The Second Hospital Affiliated to Soochow University.Record the basic information of patients and results of laboratory examination.The parameters of the PiCCO include CO?SV?ELVW?SVRI and so on.At the same time points,Conduct transthoracic echocardiography to measure ejection fraction(EF),stroke volume(SV1),aortic valve velocity(AV),velocity time integral(VTI).3 parts of the upper extremity arteries(brachial artery in the cubital fossa(BA),radical artery at the wrist(RA),and radical artery at the anatomical snuffbox(SB))were scanned by Doppler ultrasound,and the resistance index(RI)for each artery region was calculated.Renal blood flow was measured using pulsed Doppler imaging in a longitudinal section.Interlobular artery flow velocity was assessed three to five times in one of the two kidneys,and RI was calculate.Take the results of PiCCO as criteria,such as SVRIandSV,then evaluate the correlation between SV1?AV?VTI and SV,the correlation between BARI?RARI?SBRI and SVRI,RRI and Scr ?glomerular filtration rate(GFR).Assess RRI in detecting Acute kidney injury(AKI)and describe the distribution between AKI group and non AKI group.Results:(1)There were 31 males and 23 females with a minimum age of 31 years,a maximum age of 89 years(mean age of 61.8±15.6).Acute physiology and chronic health evaluation(APACHEII score)was 6~39,with an average of 23±7.25 cases dead,29 cases survived.(2)38 cases acquired clear 2-D and doppler images of cardiac,the correlation coefficient between SV mearsured by PiCCO and SV mearsured by transthoracic echocardiography(TTE)was 0.839(P<0.05).The correlation coefficient between SV mearsured by PiCCO and AV?VTIwas 0.416 and 0.427respectively(P<0.05).Bland-Altman analysis showed that there is agreement of SV between PiCCO and echocardiography except of relatively high cardiac output.(3)52 cases acquired clear two dimensional and Doppler spectrum images of the upper limb artery,there were 2 cases did not acquired the images of radical artery at the wrist and 1 case did not acquired the image of radical artery at the anatomical snuffbox.The correlation between SVRI and RI for all patients was significant for the BA and SB(P<0.05),the correlation coefficient were 0.414,0.519 respectively.The ROC showed that the area under the curve of SBRI in predicting SVRI>2400 was 0.798(P<0.05).The cut-off value of SBRI was 1.015,the sensitivity was 76.9%,the specificity was 87.2%.(4)34 cases acquired clear 2-D and doppler images of renal vascular.The correlation coefficient between RRI and serum creatinine(Scr)?GFR were 0.490?-0.516 respectively,P<0.05.The ROC showed that the area under the curve of RRI in detecting AKI was 0.712(P<0.05).The cut-off value of RRI was 0.70,the sensitivity was 81.3%,the specificity was 55.6%.RRI was increased in patients who developed AKI compared with non AKI((0.748±0.073)vs.(0.686±0.087)).Conclusions:(1)SV?AV and VTI measured by TTE may assess the left ventricular systolic function in the case of patients without abnormal left ventricular morphology and localized wall motion abnormalities.(2)RI measured at the BA?SB,especially at SB may serve as an indicator of peripheral vascular resistance.(3)RRI is related to Scr and GFR,and RRI>0.70 can predict the onset of AKI.So RRI may assess renal function earlier. |
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