心脏术后急性肾损伤的防治研究进展

心脏术后发生急性肾损伤(AKI)是比较常见且较严重的并发症之一,其中将近1%的患者需要透析治疗。体外循环期间若发生血流动力学紊乱、低流量、低灌注压等均可使肾血管收缩、血流量减少,导致机体内环境发生一系列的病理生理变化而发生AKI。近年来,由于体外循环设备日趋完善以及手术质量的提高,体外循环灌注引起肾功能不全的发病率趋于下降,但危重患者手术,如大血管手术、复杂先天性心脏病的矫治以及多瓣膜置换等因长时间体外转流和主动脉血流阻断后发生肾功能损害的概率仍然较高。采取早期预防性保护治疗措施可影响AKI的早期和晚期生存率。

Research Progress of Prevention and Treatment of Acute Kidney Injury Associated with Cardiac Surgery

Acute kidney injury(AKI)is a common and serious complication associated with heart surgery and requires dialysis in 1% of the cases.Postoperative AKI after cardiopulmonary bypass(CPB)is caused by many factors,such as renal vascular contraction and blood flow diminish induced by hemodynamics disorder,low flow,low perfusion pression.In recent years,with the development of CPB equipment and the improvement of operation quality,the morbidity of AKI during CPB is in a down trend.But some operations like critically ill patients with large vascular surgery,complex congenital heart disease operation and multiple valve replacement still have high renal damage incidence due to the long time CPB and aortic blood flow block.Early preventive protective therapies for AKI may impact the early and late survival rate.