usfdУльтразвуковая и функциональная диагностикаUltrasound & Functional Diagnostics1607-07712408-9494RDS-Media Ltd.10.24835/1607-0771-435usfd-435Research ArticleУльтразвуковая диагностика заболеваний внутренних органовGeneral UltrasoundВозможности ультразвуковой шкалы VExUS в прогнозировании острого повреждения почек у пациентов после кардиохирургических операцийThe capabilities of the VExUS ultrasound scale in predicting acute kidney injury in patients after cardiac surgeryhttps://orcid.org/0009-0000-3859-2206КлименцоваН. С.KlimentsovaN. S.

Клименцова Наталья Сергеевна – врач лаборатории ультразвуковой диагностики отдела клинической физиологии, инструментальной и лучевой диагностики НКЦ № 1 ФГБНУ “Российский научный центр хирургии имени академика Б.В. Петровского”, Москваhttps://orcid.org/0009-0000-3859-2206

Natalia S. Klimentsova – physician of the ultrasound diagnostics laboratory of the department of clinical physiology, instrumental and radiation diagnostics of Scientific and Clinical Center No. 1, Petrovsky Russian Research Center of Surgery, Moscowhttps://orcid.org/0009-0000-3859-2206

klimentsovanatali95@mail.ruhttps://orcid.org/0000-0002-6202-8506КамаловЮ. Р.KamalovYu. R.

Камалов Юлий Рафаэльевич – доктор мед. наук, профессор,

 заведующий лабораторией ультразвуковой диагностики отдела клинической физиологии, инструментальной и лучевой диагностики НКЦ № 1 ФГБНУ “Российский научный центр хирургии имени академика Б.В. Петровского”, Москваhttps://orcid.org/0000-0002-6202-8506

Yuliy R. Kamalov – MD, PhD, Professor,

Head of the Ultrasound Diagnostics Laboratory, Department of Clinical Physiology, Instrumental and Radiation Diagnostics, Scientific and Clinical Center No. 1, Petrovsky Russian Research Center of Surgery, Moscowhttps://orcid.org/0000-0002-6202-8506

https://orcid.org/0000-0002-1059-3773ПлатоваЕ. Н.PlatovaE. N.

Платова Елена Николаевна – канд. мед. наук, ведущий научный сотрудник лаборатории ультразвуковой диагностики отдела клинической физиологии, инструментальной и лучевой диагностики НКЦ № 1, ФГБНУ “Российский научный центр хирургии имени академика Б.В. Петровского”, Москваhttps://orcid.org/0000-0002-1059-3773

Elena N. Platova – MD, PhD (Med.), Leading Researcher, Ultrasound Diagnostics Laboratory, Department of Clinical Physiology, Instrumental and Radiation Diagnostics, Scientific and Clinical Center No. 1, Petrovsky Russian Research Center of Surgery, Moscowhttps://orcid.org/0000-0002-1059-3773

https://orcid.org/0000-0001-9862-8266КрыжановскаяЕ. Ю.KryzhanovskayaE. Yu.

Крыжановская Евгения Юрьевна – канд. мед. наук, ведущий научный сотрудник лаборатории ультразвуковой диагностики отдела клинической физиологии, инструментальной и лучевой диагностики НКЦ № 1 ФГБНУ “Российский научный центр хирургии имени академика Б.В. Петровского”, Москваhttps://orcid.org/0000-0001-9862-8266

Evgenia Yu. Kryzhanovskaya – MD, PhD (Med.), Leading Researcher, Ultrasound Diagnostics Laboratory, Department of Clinical Physiology, Instrumental and Radiation Diagnostics, Scientific and Clinical Center No. 1, Petrovsky Russian Research Center of Surgery, Moscowhttps://orcid.org/0000-0001-9862-8266

Государственный научный центр Российской Федерации ФГБНУ “Российский научный центр хирургии имени академика Б.В. Петровского”РоссияPetrovsky Russian Research Center of SurgeryRussian FederationГосударственный научный центр Российской Федерации ФГБНУ “Российский научный центр хирургии имени академика Б.В. Петровского”РоссияPetrovsky Russian Research Center of SurgeryRussian Federation20221801202200Принято в печать435Copyright © Клименцова Н.С., Камалов Ю.Р., Платова Е.Н., Крыжановская Е.Ю., 20222022Клименцова Н.С., Камалов Ю.Р., Платова Е.Н., Крыжановская Е.Ю.Klimentsova N.S., Kamalov Y.R., Platova E.N., Kryzhanovskaya E.Y.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://usfd.rdsmedia.ru/jour/article/view/435Цель исследования

Цель исследования: оценить возможности шкалы VExUS в выявлении пациентов с высоким риском развития острого повреждения почек (ОПП) после кардиохирургических операций.

Материал и методы

Материал и методы. В исследование было включено 69 пациентов, перенесших кардиохирургическое вмешательство. Средний возраст пациентов составил 59 лет (от 50 до 80 лет). Среди них мужчин было 48 (69,6%), женщин – 21 (30,4%). Всем пациентам выполнялась ультразвуковая оценка венозного застоя по протоколу VExUS (оценка диаметра нижней полой вены, допплеровское исследование форм кровотока в печеночных, портальной и внутрипочечных венах). Исследование проводилось до операции и в раннем послеоперационном периоде. ОПП диагностировали в соответствии с критериями KDIGO (Kidney Disease Outcomes Quality Initiative).

Результаты

Результаты. У 25 (36,2%) пациентов в раннем послеоперационном периоде развилось ОПП. При сравнении групп пациентов с ОПП и без ОПП статистически значимые различия в распределении степеней венозного застоя по шкале VExUS выявлены только в первые 24 ч после операции (p = 0,036). При отдельном анализе выраженный венозный застой (VExUS 3-й степени) статистически значимо чаще выявлялся у пациентов с ОПП (p = 0,013), тогда как при использовании порогового значения VExUS ≥ 2-й степени статистически значимой связи с развитием ОПП не выявлено.

Заключение

Заключение. Выраженный венозный застой (VExUS 3-й степени), выявленный в раннем послеоперационном периоде после кардиохирургического вмешательства, статистически значимо чаще выявлялся у пациентов с ОПП. Оценка венозного застоя с помощью прикроватного ультразвукового исследования по шкале VExUS может быть использована в качестве дополнительного метода выявления пациентов с высоким риском развития ОПП.

The aim

The aim: to evaluate the VExUS scale's ability to identify patients at high risk of developing acute kidney injury (AKI) after cardiac surgery.

Materials and Methods

Materials and Methods. The study included 69 patients who had undergone cardiac surgery. The average age of the patients was 59 years (range: 50 to 80 years). There were 48 (69.6%) men and 21 (30.4%) women. All patients underwent an ultrasound assessment of venous congestion using the VExUS protocol (assessment of the diameter of the inferior vena cava, Doppler examination of blood flow patterns in the hepatic, portal, and intrarenal veins). The study was conducted before surgery and in the early postoperative period. AKI was diagnosed according to the KDIGO criteria.

Results

Results. AKI developed in 25 patients (36.2%) in the early postoperative period. When comparing groups of patients with and without AKI, statistically significant differences in the distribution of venous congestion grades according to the VExUS scale were detected only in the first 24 hours after surgery (p = 0.036). In a separate analysis, severe venous congestion (VExUS grade 3) was statistically significantly more common in patients with AKI (p = 0.013), whereas using a VExUS cutoff value of grade ≥2, no statistically significant association with the development of AKI was found.

Conclusion

Conclusion. severe venous congestion (VExUS grade 3) detected in the early postoperative period after cardiac surgery was statistically significantly more common in patients with AKI. Assessment of venous congestion using bedside ultrasound using the VExUS scale can be used as an additional method for identifying patients at high risk of developing AKI.

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The authors declare that there are no conflicts of interest present.