肾脏血氧饱和度对急性肾损伤诊断意义研究进展

doi:10.12372/jcp.2023.22e0286

摘要/Abstract

摘要：

在失液、感染和免疫性疾病等多种因素作用下，由于自主调节能力相对弱，肾脏组织极易发生缺氧缺血，造成急性肾损伤（AKI）。AKI发生率高，严重影响危重患儿预后，但其缺乏适用于临床的早期诊断指标。近年来应用近红外光谱技术（NIRS）监测肾脏血氧饱和度（RrSO₂），可反映肾脏的血流灌注，间接反映肾脏功能。文章基于国内外对RrSO₂的研究进展，整理了NIRS在肾脏方面的临床应用，提出RrSO₂可作为AKI临床诊断的有力指标。

关键词: 急性肾损伤, 近红外光谱技术, 肾脏血氧饱和度

Abstract:

Under the action of various etiologies such as fluid loss, infection and immune diseases, the renal tissue is prone to hypoxia and ischemia, resulting in acute kidney injury (AKI) due to its relatively weak autonomic regulation ability. The incidence of AKI is high, which seriously affects the prognosis of critically ill children, but there is a lack of clinically applicable early diagnosis indicators. In recent years, the application of near infrared reflectance spectroscopy (NIRS) to monitor renal oxygen saturation (RrSO₂) can reflect renal blood perfusion and indirectly reflect renal function. Based on the research progress of RrSO₂ at home and abroad, this paper summarized the clinical application of NIRS in kidney, and proposed that RrSO₂ could be used as a powerful indicator for clinical diagnosis of AKI.

Key words: acute kidney injury, near infrared reflectance spectroscopy, renal oxygen saturation

张津铭, 王丽杰. 肾脏血氧饱和度对急性肾损伤诊断意义研究进展[J]. 临床儿科杂志, 2023, 41(4): 316-320.

ZHANG Jinming, WANG Lijie. Research progress of renal oxygen saturation in the diagnosis of acute kidney injury ZHANG Jinming, WANG Lijie[J]. Journal of Clinical Pediatrics, 2023, 41(4): 316-320.

参考文献 40

[1]	周国平. 急性肾损伤的诊断与治疗进展[J]. 中华实用儿科临床杂志, 2013, 28(9): 717-720.
[2]	Abbasciano RG, Hoxha S, Gaburro D, et al. Impact on renal function and hospital outcomes of an individualized management of cardiopulmonary bypass in congenital heart surgery: a pilot study[J]. Pediatr Cardiol, 2021, 42(8): 1862-1870. doi: 10.1007/s00246-021-02680-4 pmid: 34296332
[3]	Komaru Y, Inokuchi R, Iwagami M, et al. Correlation between the incidence and attributable mortality fraction of acute kidney injury: a systematic review[J]. Blood Purif, 2020, 49(4): 386-393. doi: 10.1159/000505568
[4]	Liberio BM, Brinton JT, Gist KM, et al. Risk factors for acute kidney injury in neonates with congenital diaphragmatic hernia[J]. J Perinatol, 2021, 41(8): 1901-1909. doi: 10.1038/s41372-021-01119-1 pmid: 34120147
[5]	Parikh AC, Tullu MS. A study of acute kidney injury in a tertiary care pediatric intensive care unit[J]. J Pediatr Intensive Care, 2021, 10(4): 264-270. doi: 10.1055/s-0040-1716577 pmid: 34745699
[6]	Niaz T, Stephens EH, Gleich SJ, et al. Acute kidney injury and renal replacement therapy after fontan operation[J]. Am J Cardiol, 2021, 161: 84-94. doi: 10.1016/j.amjcard.2021.08.056 pmid: 34794622
[7]	Zhang Y, Xiang B, Wu Y, et al. Risk factors and associated outcomes of early acute kidney injury in pediatric liver transplant recipients: a retrospective study[J]. J Pediatr Surg, 2020, 55(3): 446-450. doi: S0022-3468(19)30507-X pmid: 31466815
[8]	张婷, 李晓文. 影响新生儿急性肾损伤预后的危险因素分析[J]. 临床儿科杂志, 2021, 39(9): 646-649.
[9]	Van den Eynde J, Rotbi H, Gewillig M, et al. In-hospital outcomes of acute kidney injury after pediatric cardiac surgery: a meta-analysis[J]. Front Pediatr, 2021, 9: 733744. doi: 10.3389/fped.2021.733744
[10]	McCormick M, Richardson T, Warady BA, et al. Acute kidney injury in paediatric patients with sickle cell disease is associated with increased morbidity and resource utilization[J]. Br J Haematol, 2020, 189(3): 559-565. doi: 10.1111/bjh.v189.3
[11]	Bjornstad EC, Muronya W, Smith ZH, et al. Incidence and epidemiology of acute kidney injury in a pediatric Malawian trauma cohort: a prospective observational study[J]. BMC Nephrol, 2020, 21(1): 98. doi: 10.1186/s12882-020-01755-3 pmid: 32169046
[12]	Bellomo R, Ronco C, Kellum JA, et al. Acute renal failure-definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group[J]. Crit Care, 2004, 8(4): R204-R212. doi: 10.1186/cc2872
[13]	Palevsky PM, Liu KD, Brophy PD, et al. KDOQI US commentary on the 2012 KDIGO clinical practice guideline for acute kidney injury[J]. Am J Kidney Dis, 2013, 61(5): 649-672. doi: 10.1053/j.ajkd.2013.02.349 pmid: 23499048
[14]	王丽杰, 刘春峰. 超声导向的儿童急性肾损伤治疗[J]. 中国小儿急救医学, 2021, 28(4): 264-268.
[15]	闫文娟, 张炯. 急性肾损伤的研究进展[J]. 临床与病理杂志, 2019, 39(7): 1571-1575.
[16]	Fuhrman DY, Kellum JA, Joyce EL, et al. The use of urinary biomarkers to predict acute kidney injury in children after liver transplant[J]. Pediatr Transplant, 2020, 24(1): e13608.
[17]	李青, 张琦, 王晓宇, 等. 先天性心脏病患儿术后急性肾损伤的影响因素及尿NGAL、KIM-1的诊断价值分析[J]. 现代生物医学进展, 2021, 21(18): 3515-3519.
[18]	Vijay P, Lal BB, Sood V, et al. Cystatin C: best biomarker for acute kidney injury and estimation of glomerular filtration rate in childhood cirrhosis[J]. Eur J Pediatr, 2021, 180(11): 3287-3295. doi: 10.1007/s00431-021-04076-1 pmid: 33978827
[19]	Yoneyama F, Okamura T, Takigiku K, et al. Novel urinary biomarkers for acute kidney injury and prediction of clinical outcomes after pediatric cardiac surgery[J]. Pediatr Cardiol, 2020, 41(4): 695-702. doi: 10.1007/s00246-019-02280-3 pmid: 31872282
[20]	汪守平, 邓丽静. 小儿心脏术后急性肾损伤的诊断和治疗[J]. 四川医学, 2021, 42(2): 205-208.
[21]	Shankar V, Raj A, Singhal S, et al. Doppler-derived renal resistive index helps predict acute kidney injury in patients undergoing living-related liver transplantation[J]. Clin Transplant, 2021, 35(5): e14263.
[22]	Neunhoeffer F, Wiest M, Sandner K, et al. Non-invasive measurement of renal perfusion and oxygen metabolism to predict postoperative acute kidney injury in neonates and infants after cardiopulmonary bypass surgery[J]. Br J Anaesth, 2016, 117(5): 623-634. pmid: 27799177
[23]	EL-Sadek AE, El-Gamasy MA, Behiry EG, et al. Plasma cystatin C versus renal resistive index as early predictors of acute kidney injury in critically ill neonates[J]. J Pediatr Urol, 2020, 16(2): 206.
[24]	Chakravarti SB, Mittnacht AJ, Katz JC, et al. Multisite near-infrared spectroscopy predicts elevated blood lactate level in children after cardiac surgery[J]. J Cardiothorac Vasc Anesth, 2009, 23(5): 663-667. doi: 10.1053/j.jvca.2009.03.014 pmid: 19447648
[25]	Joffe R, Al Aklabi M, Bhattacharya S, et al. Cardiac surgery-associated kidney injury in children and renal oximetry[J]. Pediatr Crit Care Med, 2018, 19(9): 839-845. doi: 10.1097/PCC.0000000000001656
[26]	Zhang D, Ouyang C, Zhao X, et al. Renal tissue desaturation and acute kidney injury in infant cardiac surgery: a prospective propensity score-matched cohort study[J]. Br J Anaesth, 2021, 127(4): 620-628. doi: 10.1016/j.bja.2021.06.045
[27]	Lau PE, Cruz S, Garcia-Prats J, et al. Use of renal near-infrared spectroscopy measurements in congenital diaphragmatic hernia patients on ECMO[J]. J Pediatr Surg, 2017, 52(5): 689-692. doi: S0022-3468(17)30047-7 pmid: 28190559
[28]	Ortega-Loubon C, Fernández-Molina M, Fierro I, et al. Postoperative kidney oxygen saturation as a novel marker for acute kidney injury after adult cardiac surgery[J]. J Thorac Cardiovasc Surg, 2019, 157(6): 2340-2351. doi: S0022-5223(18)32785-5 pmid: 30459107
[29]	魏碧玉, 高明龙, 吴庭楣, 等. 肾区域组织氧饱和度预测紫绀型患儿心脏手术后急性肾损伤的效果[J]. 临床麻醉学杂志, 2020, 36(1): 8-12.
[30]	Jöbsis FF. Noninvasive, infrared monitoring of cerebral and myocardial oxygen sufficiency and circulatory parameters[J]. Science, 1977, 198(4323): 1264-1267. doi: 10.1126/science.929199 pmid: 929199
[31]	Giannini I, Ferrari M, Carpi A, et al. Rat brain monitoring by near-infrared spectroscopy: an assessment of possible clinical significance[J]. Physiol Chem Phys, 1982, 14(3): 295-305. pmid: 7185063
[32]	Vaughan DL, Wickramasinghe YA, Russell GI, et al. Is allopurinol beneficial in the prevention of renal ischaemia-reperfusion injury in the rat?: evaluation by near-infrared spectroscopy[J]. Clin Sci (Lond), 1995, 88(3): 359-364. doi: 10.1042/cs0880359
[33]	Solevåg AL, Schmölzer GM, Nakstad B, et al. Association between brain and kidney near-infrared spectroscopy and early postresuscitation mortality in asphyxiated newborn piglets[J]. Neonatology, 2017, 112(1): 80-86. doi: 10.1159/000458515 pmid: 28380491
[34]	Al-Subu AM, Hacker TA, Eickhoff JC, et al. Two-site regional oxygen saturation and capnography monitoring during resuscitation after cardiac arrest in a swine pediatric ventricular fibrillatory arrest model[J]. J Clin Monit Comput, 2020, 34(1): 63-70. doi: 10.1007/s10877-019-00291-2 pmid: 30820870
[35]	刘珊珊, 李恩有. 脑氧饱和度监测在老年患者中的应用进展[J]. 中华临床医师杂志(电子版), 2013, 7(24): 11798-11800.
[36]	Gumulak R, Lucanova LC, Zibolen M. Use of near-infrared spectroscopy (NIRS) in cerebral tissue oxygenation monitoring in neonates[J]. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub, 2017, 161(2): 128-133. doi: 10.5507/bp.2017.012 pmid: 28360433
[37]	谢越涛, 邢大军, 姚翠翠, 等. 肾氧饱和度监测在婴幼儿非紫绀型先心病手术中的应用及临床意义[J]. 中国医药导报, 2018, 15(18): 154-157.
[38]	Loomba RS, Rausa J, Sheikholeslami D, et al. Correlation of near-infrared spectroscopy oximetry and corresponding venous oxygen saturations in children with congenital heart disease[J]. Pediatr Cardiol, 2022, 43(1): 197-206. doi: 10.1007/s00246-021-02718-7
[39]	Biedrzycka A, Lango R. Tissue oximetry in anaesthesia and intensive care[J]. Anaesthesiol Intensive Ther, 2016, 48(1): 41-48. doi: 10.5603/AIT.2016.0005 pmid: 26966109
[40]	Bailey SM, Mally PV. Review of splanchnic oximetry in clinical medicine[J]. J Biomed Opt, 2016, 21(9): 091306. doi: 10.1117/1.JBO.21.9.091306