术中肾动脉阻力指数用于预测心脏手术后急性肾损伤的效果  

Effect of intraoperative renal artery resistance index in predicting postoperative acute kidney injury after cardiac surgery

作　　者：张转[1] 陈超 张芯绮 袁博 殷佳佳 张荦 张建友 富智 王强 郁言龙 ZHANG Zhuan;CHEN Chao;ZHANG Xinqi;YUAN Bo;YIN Jiajia;ZHANG Luo;ZHNAG Jianyou;FU Zhi;WANG Qiang;YU Yanlong(Department of Anesthesiology,the Affiliated Hospital of Yangzhou University,Yangzhou 225012,China)

机构地区：[1]扬州大学附属医院麻醉科,225012 [2]扬州大学附属医院心脏大血管中心,225012 [3]新疆医科大学儿科学院

出　　处：《临床麻醉学杂志》2024年第9期944-948,共5页Journal of Clinical Anesthesiology

基　　金：江苏省科技厅社会发展面上项目(BE2023749);江苏省中医药科技发展计划项目(MS2022151);扬州市科技局社会发展项目(YZ2022108)。

摘　　要：目的探讨心肺转流(CPB)心脏手术中肾动脉阻力指数(RI)用于预测术后急性肾损伤(AKI)的效果。方法选择择期行CPB心脏手术患者44例,男21例,女23例,年龄≥18岁,BMI 18.5~30.0 kg/m^(2),ASAⅠ—Ⅲ级。于麻醉诱导后20 min(T_(1))、CPB结束后30 min(T_(2))经食管超声心动图(TEE)测量左肾动脉收缩期峰值流速(PSV)及舒张末期流速(EDV),计算出左肾动脉RI=(PSV-EDV)÷PSV。采用改善全球肾脏病预后组织(KDIGO)诊断标准判断AKI发生情况,根据术后是否发生AKI将患者分为两组:AKI组和非AKI组。采用多因素Logistic回归分析心脏手术后AKI的危险因素。结果共有16例(36%)发生AKI。与非AKI组比较,AKI组CPB时间及主动脉阻断时间明显延长(P<0.05),T_(1)、T_(2)时RI明显升高(P<0.05)。多因素Logistic回归分析显示,T_(2)时RI是AKI发生的独立危险因素。T_(2)时RI预测心脏术后AKI的AUC为0.893(95%CI 0.794~0.991,P<0.010),敏感性为84.5%,特异性为78.6%,截断值为0.720。结论术中肾动脉RI是CPB心脏手术后AKI的独立危险因素,CPB结束后30 min肾动脉RI>0.720可作为心脏手术后AKI的预测指标。Objective To investigate the effect of intraoperative renal artery resistance index(RI)in predicting postoperative acute kidney injury(AKI)in patients undergoing cardiac surgery with cardiopulmonary bypass(CPB).Methods Forty-four patients undergoing elective cardiac surgery with CPB,21 males and 23 females,aged≥18 years,BMI 18.5-30.0 kg/m^(2),ASA physical statusⅠ-Ⅲ,were selected.Left renal artery peak systolic velocity(PSV)and end-diastolic velocity(EDV)were measured by transesophageal echocardiography(TEE)20 minutes after general anesthesia induction(T_(1))and 30 minutes after CPB cessation(T_(2)).RI was calculated as(PSV-EDV)/PSV.Patients were divided into two groups:the AKI group and the non-AKI group,according to whether occurred AKI by the diagnostic criteria of the kidney disease:improving global outcomes organization(KDIGO).Logistic multivariate regression analysis was performed to identify the risk factors for AKI occurrence.Results Sixteen patients(36%)occurred AKI.Compared with the non-AKI group,the CPB duration and aortic cross-clamp duration were significantly prolonged(P<0.05),the renal artery RI at T_(1) and T_(2) were significantly increased in the AKI group(P<0.05).Multivariate logstic analysis showed that RI at T_(2) was an independent risk factor for AKI occurrence after cardiac surgery,the AUC was 0.893(95%CI 0.794-0.991,P<0.010),the sensitivity and specificity were 84.5%and 78.6%,respectively,and the cut-off value was 0.720.Conclusion Intraoperative renal artery RI in patients undergoing cardiac surgery is an independent risk factor for AKI after cardiac surgery,and renal artery RI>0.720 at 30 minutes after CPB cessation can serve as a predictive indicator for AKI after cardiac surgery.

关 键 词：肾动脉 阻力指数 急性肾损伤 心脏手术 预测 经食管超声心动图 

分 类 号：R614[医药卫生—麻醉学]