婴幼儿先天性心脏病体外循环术后急性肾损伤的相关临床危险因素

目的探讨婴幼儿先天性心脏病(CHD)体外循环(CPB)术后急性肾损伤(AKI)的临床危险因素。方法选择2010年1-12月在北京安贞医院小儿心脏科住院的、年龄≤3岁的58例CHD患儿,患儿均行CPB手术。1.根据CPB时间分为3组:CPB<90 min 15例,90～149 min 25例,≥150 min 18例。2.根据CHD外科危险分层(RACHS-1)分为3组:2级26例,3级22例,4级10例。3.根据年龄分为2组:低龄组,年龄≤6个月27例;大龄组,年龄>6个月～3岁31例。AKI定义为术后48 h内血清Cr升高≥26.4μmol.L-1或较原水平增长≥50%和(或)尿量减少至<0.5 mL.kg-1.h-1达6 h(除外梗阻性肾病或脱水状态)。比较术后各组发生AKI的比例。结果 1.CPB 90～149 min组和≥150 min组术后发生AKI的比例显著高于CPB<90 min组(52.0%vs13.3%,P<0.05;77.8%vs 13.3%,P<0.001),CPB≥150 min组发生AKI的比例虽高于90～149 min组,但差异无统计学意义(P>0.05)。2.术后发生AKI的比例,RACHS-1 4级组(90.0%)及3级组(59.1%)显著高于2级组(26.9%)(4级vs 2级,P<0.01;3级vs 2级,P<0.05);4级组虽高于3级组,但差异无统计学意义(P>0.05)。3.低龄组AKI的比例高于大龄组(63.0%vs38.7%),但其差异无统计学意义(P>0.05)。结论年龄、RACHS-1分级和CPB持续时间均与CHD患儿CPB术后AKI相关,CPB时间越长、RACHS-1分级越高、年龄越小,AKI发生率越高。

Analysis of Risk Factors of Acute Renal Injury after Cardiac Surgery with Cardiopulmonary Bypass in Infants and Toddlers with Congenital Heart Disease

Objective To analyze the relative risk factors of acute kidney injury(AKI) after cardiac surgery with cardiopulmonary bypass(CPB) in infants and toddlers with congenital heart disease(CHD). Methods A total of 58 children(≤3 years old) who were underwent congenital heart surgery with CPB in the Department of Pediatric Cardiology,Beijing Anzhen Hospital from Jan.to Dec.2010 were enrolled in this research.1.According to CPB durations,the patients were divided into 3 groups:CPB<90 min group(n=15);90-149 min group(n=25);and CPB≥150 min group(n=18).2.According to Risk Adjusted Classification of Congenital Heart Surgery(RACHS-1)categories,the patients were divided into 3 groups:category 2 group(n=26);category 3 group(n=22);and category 4 group(n=10).3.According to the age,the patients were divided into 2 groups:younger group,≤6 months(n=27);and elder group,>6 months-3 years(n=31). Results 1.The incidences of AKI in the CPB 90-149 min group and ≥150 min group were significantly higher than that in <90 min group(52.0% vs 13.3%,P<0.05;77.8% vs 13.3%,P<0.001).The incidence of AKI in the ≥150 min group was higher than that in 90-149 min group,but the difference was not significant(P>0.05).2.The incidence of AKI after surgery was 26.9% in category 2 group,59.1% in category 3 group,and 90.0% in category 4 group(category 4 vs category 2,P<0.01;category 4 vs category 3,P>0.05;category 3 vs category 2,P<0.05).3.The younger group had a higher incidence of AKI than the elder group(63.0% vs 38.7%),but the difference was not significant(P>0.05). Conclusions CPB duration,RACHS-1 category and age are relative risk factors of AKI after congenital heart surgery with CPB in infants and toddlers.The incidence of AKI will be higher in the patients with Longer duration of CPB,higher RACHS-1 and lower age.