肾氧饱和度监测对非发绀型先天性心脏病术后急性肾损伤的临床预测价值  

Clinical Predictive Value of Renal Oxygen Saturation Monitoring for Postoperative Acute Kidney Injury in Non-cyanotic Congenital Heart Disease

作　　者：李红云 魏嵘 李佳[2] 秦文俊 张儒舫[2] 李小兵[2] LI Hongyun;WEI Rong;LI Jia(Department of Anesthesiology,Shanghai Children′s Hospital,School of Medicine,Shanghai Jiao Tong University,Shanghai 200062,China)

机构地区：[1]上海市儿童医院、上海交通大学医学院附属儿童医院麻醉科,200062 [2]上海市儿童医院、上海交通大学医学院附属儿童医院心胸外科,200062

出　　处：《医学研究杂志》2023年第4期163-167,共5页Journal of Medical Research

摘　　要：目的 通过连续监测非发绀型先天性心脏病(congenital heart disease, CHD)术中肾氧饱和度(renal oxygen saturation, RrSO2),评估术中RrSO2预测术后急性肾损伤(acute kidney injury, AKI)的可行性,并探讨术后AKI的危险因素。方法 回顾性分析2020年1月~2021年6月在上海市儿童医院体外循环(cardiopulmonary bypass, CPB)下行手术治疗的非发绀型CHD患儿的临床资料,记录麻醉开始时(T1)、手术开始5min(T2)、CPB开始5min(T3)、CPB开始20min(T4)、主动脉开放5min(T5)、CPB结束时(T6)的RrSO2、平均动脉压(mean arterial pressure, MAP)、动脉血气分析,记录CPB时间、主动脉阻断时间。根据术后是否发生AKI将患儿分为AKI组与非AKI组。分析两组患儿的临床资料,评估RrSO2预测术后发生AKI的可行性,将单因素分析中差异有统计学意义的因素纳入多因素Logistic回归分析预测术后发生AKI的危险因素。结果 共收集86例患儿,术后20例发生了AKI,发生率为23.26%。两组患儿各时间点RrSO2比较,差异均无统计学意义(P均>0.05)。单因素分析结果显示,年龄、体重、CPB期间MAP、乳酸、氧分压与术后发生AKI相关(P<0.05);多因素Logistic回归分析结果显示,年龄(OR=0.877,95%CI:0.771~0.998,P=0.046)、体重(OR=1.562,95%CI:1.010~2.416,P=0.045)、T6时乳酸(OR=3.178,95%CI:1.117~9.036,P=0.030)与术后发生AKI独立相关。结论 目前没有足够的证据表明术中RrSO2可以预测非发绀型CHD术后AKI的发生。Objective By continuously monitoring renal oxygen saturation(RrSO 2)during non-cyanotic congenital heart disease(CHD)surgery to evaluate the feasibility of intraoperative RrSO 2 in predicting postoperative acute kidney injury(AKI),and to explore the risk factors of AKI.Methods Children who underwent non-cyanotic CHD surgery under cardiopulmonary bypass(CPB)in Shanghai Children′s Hospital from January 2020 to June 2021 were retrospectively analyzed.RrSO 2,mean arterial pressure(MAP),arterial blood gas analysis were recorded at the following time points:after anesthesia induction(T 1),5min from the start of surgery(T 2),5min from the start of CPB(T 3),20min from the start of CPB(T 4),5min from the opening of the aorta(T 5)and at the end of CPB(T 6).The CPB time and aortic occlusion time were recorded.All patients were divided into AKI group and non-AKI group according to the occurrence of AKI.The clinical data of the two groups of children were analyzed to evaluate the feasibility of RrSO 2 in predicting postoperative AKI.Factors with statistically significant differences in univariate analysis were incorporated into multivariate Logistic regression to predict the risk factors for the occurrence of postoperative AKI.Results A total of 20 patients developed AKI after surgery among 86 patients,the incidence rate of AKI was 23.26%.There was no statistical difference in RrSO 2 at each time point between the two groups.Univariate analysis showed that age,weight,MAP,lactate,and oxygen partial pressure during CPB were associated with the the occurrence of postoperative AKI.Multivariate Logistic regression analysis showed that age(OR=0.877,95%CI:0.771-0.998,P=0.046),weight(OR=1.562,95%CI:1.010-2.416,P=0.045)and lactate at T 6(OR=3.178,95%CI:1.117-9.036,P=0.030)were independently associated with the the occurrence of postoperative AKI.Conclusion At present,there is insufficient evidence that intraoperative RrSO 2 can predict the occurrence of postoperative AKI in non-cyanotic CHD.

关 键 词：儿童 急性肾损伤 肾氧饱和度 非发绀型先天性心脏病 

分 类 号：R726[医药卫生—儿科]