儿童非紫绀型先心病体外循环术后急性肾损伤相关危险因素分析

摘要： 目的 探讨儿童非紫绀型先天性心脏病体外循环 （CPB） 心脏手术后急性肾损伤 （AKI） 的发病情况及相关危险因素。方法 回顾性分析 2012 年 5 月-2014 年 5 月行 CPB 心脏手术的患儿 150 例， 根据术后是否发生 AKI 分为 AKI 组 29 例和非 AKI 组 121 例。收集患儿性别、 年龄、 基础血肌酐值等相关临床资料， 比较 2 组间临床指标的差异， 并采用多因素 Logistic 回归分析 AKI 发生的相关危险因素。结果 全组无死亡， 组间比较分析显示年龄、 肺炎和（或）心衰史、 基础血肌酐值、 基础尿酸值、 体质量、 CPB 时间、 主动脉阻断时间、 术后输血量、 机械通气时间及低血压差异有统计学意义。Logistic 回归分析显示， 年龄 （≤1 岁）、 肺炎和 （或） 心衰史、 CPB 时间 （>40 min）、 主动脉阻断时间（>30 min）是 CPB 术后发生 AKI 的危险因素。结论 选择儿童手术的最佳年龄、 积极预防术前并发症、 缩短 CPB 和主动脉阻断时间对预防 AKI 的发生有重要作用。

Risk factors for acute kidney injury after cardiopulmonary bypass operation in children with non cyanotic congenital heart disease

Abstract： Objective To investigate the incidence and risk factors of acute kidney injury (AKI) after cardiopulmonary bypass(CRB) in children with non cyanotic congenital heart disease. Methods A total of 150 children who underwent car⁃ diopulmonary bypass operation from 2012 May to 2014 May were analyzed retrospectively. The patients were divided into two groups: AKI group (n=29) and non AKI group (n=121). Clinical data were collected and compared between two groups, including gender, age and baseline serum creatinine level. Multivariate Logistic regression analysis was used to evaluate the risk factors for AKI after operation. Results There was no death in the 150 cases. Comparison between groups, there were significant differences in age, history of heart failure and (or)pneumonia, baseline serum creatinine level, baseline uric acid, body mass, CPB) time, aortic clamping time, mechanical ventilation time, postoperative transfusion and hypotension. Multi⁃ variate Logistic regression analysis showed that age (≤1 years old), the history of pneumonia and (or) heart failure, CPB time (>40 min), aortic clamping time (>30 min) were the independent risk factors for AKI after operation. Conclusion It is im⁃ portant to choose the best age for surgery in children, actively prevent preoperative complications and shorten the CPB and aorta blocking time for preventing the occurrence of AKI.