白蛋白与纤维蛋白原比值对体外循环下室间隔缺损修补术患儿术后急性肾损伤的预测价值  

Predictive value of albumin-to-fibrinogen ratio for acute kidney injury in infants undergoing ventricular septal defect repair with cardiopulmonary bypass

作　　者：陈静 赵孟天 李传应 张健 Chen Jing;Zhao Mengtian;Li Chuanying;Zhang Jian(Department of Cardiovascular Surgery,Anhui Children's Hospital,Hefei 230051,Anhui,China;Department of Neonatal Surgery,Anhui Children's Hospital,Hefei 230051,Anhui,China;Department of Gastroenterology,Anhui Children's Hospital,Hefei 230051,Anhui,China)

机构地区：[1]安徽省儿童医院心血管外科,合肥230051 [2]安徽省儿童医院新生儿外科,合肥230051 [3]安徽省儿童医院消化内科,合肥230051

出　　处：《中华危重病急救医学》2024年第5期527-531,共5页Chinese Critical Care Medicine

基　　金：安徽省卫生健康科研项目(AHWJ2022b087)。

摘　　要：目的探讨白蛋白与纤维蛋白原比值(AFR)对体外循环(CPB)下室间隔缺损修补术患儿术后急性肾损伤(AKI)的预测价值。方法回顾性选择2019年1月至2023年7月就诊于安徽省儿童医院诊断为室间隔缺损的患儿,依照术后住院期间是否发生AKI将患儿分为AKI组和非AKI组。收集患儿人口学资料、术前资料、术中数据、术后数据以及CPB期间实验室检查结果,采用多因素Logistic回归分析筛选CPB下室间隔缺损修补术术后AKI的影响因素。绘制受试者工作特征曲线(ROC曲线),分析AFR对CPB下室间隔缺损修补术术后AKI的预测价值。结果共纳入215例患儿,其中AKI组28例,非AKI组187例。两组患儿年龄、性别、体质量、身高、肺炎史、慢性心力衰竭史比较差异均无统计学意义,但AKI组患儿左室射血分数(LVEF)明显低于非AKI组(0.526±0.028比0.538±0.030,P=0.048)。AKI组患儿CPB时间(min:74.1±12.1比65.8±11.3,P<0.001)、主动脉阻断时间(min:41.7±9.7比37.2±9.4,P=0.021)明显长于非AKI组,低温停循环比例明显高于非AKI组(21.4%比8.6%,P=0.047),而两组术中超滤比例和尿量差异无统计学意义。AKI组患儿重症监护病房(ICU)住院时间明显长于非AKI组(d:5.3±2.0比4.0±1.7,P<0.001),但两组机械通气时间和术后低血压比例差异无统计学意义。AKI组患儿CPB期间血糖(mmol/L:9.4±1.3比8.8±0.8,P<0.001)、血乳酸(mmol/L:2.2±0.3比2.0±0.3,P=0.015)、血肌酐(μmol/L:79.7±11.5比74.4±10.9,P=0.018)水平明显高于非AKI组,AFR明显低于非AKI组(8.5±1.3比10.2±1.6,P<0.001),而两组CPB期间血红蛋白、血尿素氮、丙氨酸转氨酶、天冬氨酸转氨酶水平差异均无统计学意义。多因素Logistic回归分析结果显示,AFR是CPB下室间隔缺损修补术术后AKI的保护因素〔优势比(OR)=0.439,95%可信区间(95%CI)为0.288~0.669,P<0.001〕;血糖(OR=2.133,95%CI为1.239~3.672,P=0.006)、血乳酸(OR=5.568,95%CI为1.102~28.149,P=0.038)是CPB下室间隔缺损修Objective To investigate the predictive value of albumin-to-fibrinogen ratio(AFR)for postoperative acute kidney injury(AKI)in infants with ventricular septal defect repair under cardiopulmonary bypass(CPB).Methods A retrospective analysis was conducted on infants diagnosed with ventricular septal defect in Anhui Children's Hospital from January 2019 to July 2023.The infants were divided into AKI group and non-AKI group according to whether AKI occurred in hospital after operation.Demographic data,preoperative data,intraoperative data,postoperative data and laboratory results during CPB were collected.Multivariate Logistic regression analysis was used to find the factors of AKI after ventricular septal defect repair with CPB.Receiver operator characteristic curve(ROC curve)was drawn to analyze the predictive value of AFR for postoperative AKI after ventricular septal defect repair with CPB.Results A total of 215 children were collected,including 28 in AKI group and 187 in non-AKI group.There were no significant differences in age,gender,body weight,height,history of pneumonia and history of chronic heart failure between the two groups,but the left ventricular ejection fraction(LVEF)in the AKI group was significantly lower than that in the non-AKI group(0.526±0.028 vs.0.538±0.030,P=0.048).The duration of CPB(minutes:74.1±12.1 vs.65.8±11.3,P<0.001),aortic cross-clamping(minutes:41.7±9.7 vs.37.2±9.4,P=0.021)and hypothermic circulation arrest(21.4%vs.8.6%,P=0.047)in AKI group were significantly higher than those in non-AKI group,but there were no significant differences in the proportion of ultrafiltration and urine volume between the two groups.The length of intensive care unit(ICU)stay in AKI group was significantly longer than that in non-AKI group(days:5.3±2.0 vs.4.0±1.7,P<0.001),but there were no significant differences in duration of mechanical ventilation and the proportion of postoperative hypotension between the two groups.During CPB,the levels of blood glucose(mmol/L:9.4±1.3 vs.8.8±0.8,P<0.001),blo

关 键 词：白蛋白与纤维蛋白原比值 室间隔缺损 体外循环 急性肾损伤 

分 类 号：R726.5[医药卫生—儿科]