Ultrasound assessment of the effect of patient position and body shape on peri-operative renal transplant cortical resistive indices and perfusion.

IF 0.8 Q4 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
Linda Thebridge, Charles Fisher, Vikram Puttaswamy, Carol Pollock, Jillian Clarke
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引用次数: 0

Abstract

Background: Multiple factors impact kidney perfusion peri-operatively. The aim of this study was to evaluate the effect of patient position and size on renal transplant perfusion.

Methods: Consecutive adult recipients of 123 single renal grafts were studied. Renal artery velocity, renal vein velocity and cortical resistive indices were measured in supine, oblique and decubitus positions on post-operative days 1, 3, 7 and 30, and standing on days 7 and 30.

Results: Positional resistive indices were significantly lower than the supine resistive indices except in the day 1 oblique scan. Greater reductions in resistive indices occurred in grafts with higher supine cortical resistive indices, higher renal vein velocities and greater change in renal vein velocities. Renal artery velocities, renal vein velocities and resistive indices progressively decreased with greater positional change. Although renal vein velocities correlated poorly with resistive indices in individual patients, mean resistive indices correlated well (r 2 = 0.73) with mean renal vein velocities for scans in different positions and on different days, and less so with mean renal artery velocities (r 2 = 0.37). Supine abdominal girth and change in girth with position were more strongly associated with larger changes in supine resistive indices than recipient weight, body mass index or peri-operative weight gain.

Conclusions: Peri-operative renal transplant resistive indices, renal artery velocities and renal vein velocities improve with patient positional change due to reduced compression of the graft and renal vein, with implications for post-operative ultrasound scanning protocols, documentation and reporting. Peri-operative patient position, especially for at-risk grafts, is a modifiable risk factor for poorer graft outcomes. Patients should be nursed in the decubitus position rather than supine. Abdominal girth is more relevant to pre-operative patient assessment than weight or body mass index.

超声评价患者体位和体型对肾移植围术期皮质阻力指数和灌注的影响。
背景:多因素影响围手术期肾脏灌注。本研究的目的是评估患者体位和大小对肾移植灌注的影响。方法:对连续接受成人单肾移植的123例进行研究。术后第1、3、7、30天分别采用仰卧位、斜卧位和卧位,第7、30天分别采用站立位测量肾动脉流速、肾静脉流速和肾皮质阻力指数。结果:除第1天斜位扫描外,体位电阻指数明显低于仰卧位电阻指数。在仰卧位皮质电阻指数较高、肾静脉速度较高和肾静脉速度变化较大的移植物中,电阻指数下降幅度较大。肾动脉速度、肾静脉速度和肾阻力指数随位置变化逐渐降低。尽管个别患者肾静脉流速与阻力指数相关性较差,但在不同位置和不同日期扫描时,平均阻力指数与平均肾静脉流速相关性较好(r2 = 0.73),而与平均肾动脉流速相关性较差(r2 = 0.37)。与受体体重、体重指数或围手术期体重增加相比,仰卧位腹部围以及围位随体位变化与仰卧位阻力指数变化的相关性更强。结论:肾移植围术期阻力指数、肾动脉速度和肾静脉速度随着患者体位改变而改善,因为移植物和肾静脉的压迫减少,这对术后超声扫描方案、文献和报告具有指导意义。围手术期患者体位,尤其是高危移植物体位,是移植物预后较差的一个可改变的危险因素。患者应采用卧位而不是仰卧位进行护理。与体重或体重指数相比,腹围与术前患者评估更相关。
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来源期刊
Ultrasound
Ultrasound RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING-
CiteScore
1.70
自引率
0.00%
发文量
55
期刊介绍: Ultrasound is the official journal of the British Medical Ultrasound Society (BMUS), a multidisciplinary, charitable society comprising radiologists, obstetricians, sonographers, physicists and veterinarians amongst others.
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