输血与心脏移植术后急性肾损伤相关性研究

目的研究围术期输血和心脏移植术后急性肾损伤(acute kidney injury,AKI)的相关性。方法选取2016年1月至2018年12月在广东省人民医院心外科行心脏移植术的67例患者作为研究对象。根据排除标准最后纳入63例患者,其中男53例、女10例,平均年龄(44.3±12.9)岁。将20例心脏移植术后使用连续性肾脏替代治疗(continuous renal replacement therapy,CRRT)的患者作为RT组,另外将没有使用CRRT的43例患者作为非RT组。比较两组患者基线资料、围术期输血资料及临床预后等指标。结果两组术前基线特征基本一致。两组在围术期输注红细胞量和血浆量、术后24 h出血量、是否再次手术探查等方面差异均有统计学意义(P<0.05)。多因素分析发现围术期输注红细胞量是AKI的独立危险因素(OR=1.115)。相关性分析显示肾损伤程度与围术期输注红细胞量呈正相关(r=0.686,P<0.05)。受试者工作特征(ROC)曲线下面积为0.923(95%CI 0.852~0.995,P<0.001)。经ROC曲线计算发现围术期输注红细胞超过18 mL/kg将增加心脏移植术后AKI发生率。结论围术期输血和心脏移植术后AKI密切相关,临床中输血越多肾损伤发生率越高、预后越差,建议可开展多种节约用血措施。

Correlation between blood transfusion and postoperative acute kidney injury after heart transplantation

Objective To explore the correlation between perioperative blood transfusion and acute kidney injury(AKI)after heart transplantation.Methods A retrospective study was performed on 67 patients who underwent heart transplantation in the Department of Cardiac Surgery,Guangdong Provincial People’s Hospital from January 2016 to December 2018,and finally 63 patients were included according to the exclusion criteria.There were 53 males and 10 females with an average age of 44.3±12.9 years.Twenty patients who adopted continuous renal replacement therapy(CRRT)after heart transplantation were divided into a RT group and the other 43 patients who did not use CRRT were divided into a non-RT group.Baseline characteristics,perioperative blood transfusion data and clinical prognosis were compared between the two groups.Results The preoperative baseline characteristics of the two groups were basically the same.There were significant differences in perioperative infusion of red blood cells and plasma,postoperative 24 h bleeding and re-exploration(P<0.05)between the two groups.The area under the receiver operating characteristic(ROC)curve was 0.923(95%CI 0.852 to 0.995,P<0.001).The ROC curve showed that perioperative infusion of red blood cells more than 18 mL/kg would increase the incidence of AKI after heart transplantation.Conclusion Perioperative blood transfusion is closely related to AKI after heart transplantation.The more blood transfusion is in clinics,the higher incidence of renal injury is and the worse prognosis is.It is suggested that various blood-saving measures can be carried out.