体外循环手术后急性肾损伤临床研究

目的观察体外循环（CPB）手术对肾功能的影响。方法回顾分析246例施行CPB心内直视手术后患者的临床资料、手术相关指标与肾功能相关指标。根据2005年急性肾脏损伤网络（AKIN）对于急性肾损伤（AKI）的定义，判断患者的发病情况，并比较AKI与非AKI患者的各项指标。采用简化的MDRD公式评估2组患者术前的评估肾小球滤过率（eGFR）。结果246例中，22例发生AKI，总发病率8．9％；Ⅰ、Ⅱ、Ⅲ期AKI分别为15例（6．1％）、5例（2．0％）、2例（0．8％）。与非AKI患者的各项指标比较结果显示：AKI患者年龄偏大（P〈0．05），而术前血压、血红蛋白、肾功能等指标的差异无统计学意义（P〉0．05）；eGFR明显低于非AKI患者（P〈0．05）；体外循环时间及升主动脉阻断时间明显较非AKI患者延长（P〈0．05）；术后24h内尿量较非AKI患者显著减少，而24h引流液量显著多于非AKI患者（P〈0．05）。结论患者年龄大、CPB及升主动脉阻断时间长是CPB手术后发生AKI的不利因素。术前评估eGFR可能有助于发现高危人群，利于及时采取有效措施避免AKI的发生。

Retrospective analysis of acute kidney injury after open heart surgery under cardiopulmonary bypass

Objective To investigate the effects of cardiopulmonary bypass （CPB） on renal functions. Methods The clinical data of 246 patients undergoing isolated CPB were analyzed retrospectively, combined with the relevant indexes of their surgery and renal functions, excluding hypertension, diabetes, hepatic and renal insufficiency, and preoperative administration of drugs of kidney toxicity. The patients were assessed and classified according to the definition of acute kidney injury （AKI） by the Acute Kidney Injury Network （AKIN） to compare the parameters among the AKI and non - AKI patients. The abbreviated MDRD equation was adopted to evaluate the estimated glomerular filtration rate （ eG- FR）. Results Of the 246 patients, 22 had AKI, with the prevalence rate of 8.9% , which was respectively distributed from phase 1 to 3 at the percentage of 6.1%, 2.0% and 0. 8% , respectively. Comparisons of all the indexes in both groups showed that the AKI patients were older than non - AKI patients （P 〈 0.05 ）, while there were no significant differences in the levels of blood pressure, hemoglobin and renal functions before the operation in the two groups （ P 〉 0.05）. The AKI patients＇s eGFR was （81.7± 19.3） ml ·min^-1 ·（ 1.73 m^2 ）^-1 , which was significantly lower than non - AKI patients （ 109.5 ± 28.2） （ P 〈 0.05 ）. The pump time and ascending aorta blockage time of AKI patients were longer than those of non - AKI patients （ P 〈 0.05 ）. Within 24 hours after CPB, drainage volume of AKI patients was more than that of non - AKI patients, whereas urine volume decreased remarkably （P 〈 0.05）. Conclusion The disad- vantages leading to AKI in patients include old age, prolonged duration of CPB and ascending aorta blockage. MDRD equation was a useful strategy to estimate GFR for early detection of the patients at risk and prevention of AKI.