肠和肾血氧饱和度能较好预测小儿先天性心脏病术后急性肾损伤

目的：研究脑、肠、肾区域血氧饱和度(rSO₂)预测小儿先天性心脏病术后急性肾损伤(AKI)发生的价值。方法：选择2020年1—12月在上海交通大学医学院附属上海儿童医学中心进行体外循环先天性心脏病纠治术、体重大于2.5 kg且年龄在1岁及以下的患儿57例。采用近红外光谱连续监测患儿术后48 h内脑、肠、肾rSO₂。比较AKI组与非AKI组，以及发生与未发生2级及以上AKI患儿脑、肠、肾rSO₂的变化差异，并采用ROC曲线分析肠、肾rSO₂对术后发生AKI及严重程度的预测价值。结果：57例患儿中，38例(66.7%)发生AKI，其中AKI 1级18例(47.4%),AKI 2级9例(23.7%),AKI 3级11例(28.9%),AKI总发生率约为66.7%。AKI组与非AKI组脑rSO₂的变化差异无统计学意义(F=0.012,P>0.05)，但AKI组肠rSO₂和肾rSO₂明显低于非AKI组(F=5.017和5.003，均P&l...

Prediction value of regional oxygen saturation in intestine and kidney for acute kidney injury in children with congenital heart disease after surgery

Objective: To study the prediction value of regional oxygen saturation (rSO₂) in brain, intestine and kidney for acute kidney injury (AKI) in children with congenital heart disease after surgery. Methods: Fifty-seven children with congenital heart disease (CHD), whose weight >2.5?kg and age≤1 year were treated in Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine from January 2020 to December 2020. The rSO ₂ of brain, intestine and kidney were monitored with near-infrared spectroscopy continuously for 48?h after surgery. The predictive values of cerebral, intestinal and renal rSO₂ for occurrence and severity of postoperative AKI were analyzed. Results: Among 57 patients, postoperative AKI developed in 38 cases (66.7%), including 18 cases of AKI-1 (47.4%), 9 cases of AKI-2 (23.7%) and 11 cases of AKI-3 (28.9%). There was no significant difference in cerebral rSO₂ between AKI group and non-AKI group (F=0.012, P>0.05), while the intestinal rSO₂ and renal rSO₂ in AKI group were significantly lower than those in non-AKI group (F=5.017 and 5.003, both P<0.05). There was no significant difference in brain rSO₂ between children with or without AKI-2 and above (F=0.311, P>0.05), but the intestinal rSO₂ and renal rSO₂ in children with AKI-2 and above were lower than other children (F=6.431 and 14.139, both P<0.05). The area under ROC curve (AUC) of intestinal rSO₂ 3?h after surgery for predicting AKI was 0.823, and with intestinal rSO₂ 3?h after surgery <85%, the sensitivity and specificity were 66.7% and 89.5%, respectively. The AUC of renal rSO ₂ for the diagnosis of AKI at 31?h after surgery was 0.918, and with intestinal rSO₂ 31?h after surgery <84%, the sensitivity and specificity were 72.2% and 84.2%, respectively. The AUC of intestinal rSO ₂3?h after surgery for the diagnosis of AKI-2 and above was 0.829, and with intestinal rSO₂ 3?h after surgery <84%, the sensitivity and specificity were 62.2% and 90.0%, respectively. The AUC of renal rSO ₂ for the diagnosis of AKI-2 and above was 0.826 at 34?h postoperatively, and with intestinal rSO₂ 34?h after surgery <71%, the sensitivity and specificity were 91.9% and 55.0%, respectively. Conclusion: The monitoring of intestinal and renal rSO₂ can predict the occurrence and severity of postoperative AKI in children with congenital heart disease after surgery.