CAJ | 학술논문

目的：探讨体外循环心脏瓣膜置换术后提高平均动脉压（MAP）水平能否减少急性肾损伤（AKI）的发生率。方法选择行体外循环瓣膜置换术患者共259例，根据术后MAP控制水平分为五组：61～65 mmHg组、66～70 mmHg组、71～75 mmHg、76～80 mmHg、≥81 mmHg组，回顾性比较不同术后MAP组的术后6 h乳酸清除率、AKI发生率、住ICU时间、28 d死亡率。结果五组间术后6 h乳酸清除率及住ICU时间比较，差异均有统计学意义（F分别=-33.52、-46.36，P均＜0.05）。通过LSD法比较得出，MAP维持在71～75 mmHg较其他四组患者的术后6 h乳酸清除率高（t分别=1.21、2.04、1.05、1.70，P均＜0.05），住ICU时间短（t分别=1.85、1.56、1.07、1.13，P均＜0.05）；五组患者间术后AKI发生率及28 d死亡率比较，差异均无统计学意义（χ2分别=3.53，2.45，P均＞0.05）。结论心脏瓣膜置换术后提高MAP并不能减少AKI的发生；术后MAP维持在71～75 mmHg能明显提高患者术后6 h乳酸清除率，缩短ICU住院时间。
목적：탐토체외순배심장판막치환술후제고평균동맥압（MAP）수평능부감소급성신손상（AKI）적발생솔。방법선택행체외순배판막치환술환자공259례，근거술후MAP공제수평분위오조：61～65 mmHg조、66～70 mmHg조、71～75 mmHg、76～80 mmHg、≥81 mmHg조，회고성비교불동술후MAP조적술후6 h유산청제솔、AKI발생솔、주ICU시간、28 d사망솔。결과오조간술후6 h유산청제솔급주ICU시간비교，차이균유통계학의의（F분별=-33.52、-46.36，P균＜0.05）。통과LSD법비교득출，MAP유지재71～75 mmHg교기타사조환자적술후6 h유산청제솔고（t분별=1.21、2.04、1.05、1.70，P균＜0.05），주ICU시간단（t분별=1.85、1.56、1.07、1.13，P균＜0.05）；오조환자간술후AKI발생솔급28 d사망솔비교，차이균무통계학의의（χ2분별=3.53，2.45，P균＞0.05）。결론심장판막치환술후제고MAP병불능감소AKI적발생；술후MAP유지재71～75 mmHg능명현제고환자술후6 h유산청제솔，축단ICU주원시간。
Objective To discuss whether increase the level of mean arterial pressure can reduce the incidence of acute kidney injury in patients with heart valve replacement. Methods A total of 259 cases who were undergoing heart valve re-placement surgery were divided into five groups according to the levels of mean arterial pressure: 61~65mmHg, 66~70mmHg, 71~75mmHg, 76~80mmHg and ≥81mmHg. The 6-hour lactate clearance rate, incidence of acute kidney in-jury, the length of ICU stay and 28 days mortality among groups were compared. Results The 6-hour lactate clearance rate and the length of ICU stay among five groups were statistically different (F=-33.52,-46.36,P<0.05). The highest 6-hour lactate clearance rate and the shortest length of ICU stay was seen in the group of 71~75mmHg when compared with other groups by LSD method(t=1.21, 2.04, 1.05, 1.70;1.85, 1.56, 1.07, 1.13,P<0.05).There was no significant differ-ence of AKI incidence and 28 days mortality among the groups (χ2=3.53,2.45,P>0.05). Conclusions Increasing the mean arterial pressure could not reduce the incidence of acute kidney injury in patients with heart valve replacement. The 6-hour lactate clearance rate and ICU length of stay can improved when the mean arterial pressure maintained at 71~75mmHg.