CAJ | 학술논문

目的探讨婴幼儿体外循环(cardiopulmonary bypass,CPB)心脏术后急性肾损伤(acute kidney injury,AKI)的危险因素.方法回顾性分析2012年9月到2013年1月在浙江大学医学院附属儿童医院行体外循环心内直视手术的161例婴幼儿(年龄≤3岁)先天性心脏病患者的临床资料,根据AKI的诊断标准,将其分为AKI组和非AKI组.统计术后AKI的发生情况,并进行单因素分析和Logistic回归分析法分析婴幼儿CPB术后发生AKI的危险因素.结果 (1) 161例患儿中有23例发生AKI,发生率为14.3％,即AKI组23例,非AKI组138例;AKI组中2例患儿死亡,病死率8.7％,非AKI组无患儿死亡病例;AKI组患儿SICU滞留时间及住院时间均显著高于非AKI组.(2)单因素分析结果显示年龄、体质量、术前胱抑素C (cystatin C)水平、CPB时间、主动脉阻断时间、延迟关胸、RACHS-1手术分级、术后肌酐水平、术后胱抑素C水平、IS评分、术后呼吸机使用时间、术后肺动脉高压、术后医院获得性肺炎,与术后发生AKI有关(P＜0.05),而与性别、术后心律失常无显著性关系.(3)经Logistic回归分析发现:术后胱抑素C≥1.02 mg/L、体质量≤5 kg和术后肌酐≥35.6 μmol/L是婴幼儿体外循环心脏术后发生AKI的独立危险因素,其风险分别增加8.947、6.567和5.387倍;ROC曲线下面积为0.937,提示预测AKI的敏感性和特异性均较强.结论 (1)术前评估婴幼儿CPB心脏手术患者年龄、体质量、术前胱抑素C这3项指标有助于发现高危人群;尽可能缩短手术时间,条件允许时及早撤除呼吸机,及时处理肺动脉高压和医院获得性肺炎,术后监测肌酐和胱抑素C水平可在一定程度上减少术后AKI的发生.(2)临床上可根据术前体质量、术后胱抑素C水平以及术后肌酐水平预测CPB心脏术后AKI,以期采取预防措施减少AKI的发生,改善患儿预后.
목적 탐토영유인체외순배(cardiopulmonary bypass,CPB)심장술후급성신손상(acute kidney injury,AKI)적위험인소.방법 회고성분석2012년9월도2013년1월재절강대학의학원부속인동의원행체외순배심내직시수술적161례영유인(년령≤3세)선천성심장병환자적림상자료,근거AKI적진단표준,장기분위AKI조화비AKI조.통계술후AKI적발생정황,병진행단인소분석화Logistic회귀분석법분석영유인CPB술후발생AKI적위험인소.결과 (1) 161례환인중유23례발생AKI,발생솔위14.3％,즉AKI조23례,비AKI조138례;AKI조중2례환인사망,병사솔8.7％,비AKI조무환인사망병례;AKI조환인SICU체류시간급주원시간균현저고우비AKI조.(2)단인소분석결과현시년령、체질량、술전광억소C (cystatin C)수평、CPB시간、주동맥조단시간、연지관흉、RACHS-1수술분급、술후기항수평、술후광억소C수평、IS평분、술후호흡궤사용시간、술후폐동맥고압、술후의원획득성폐염,여술후발생AKI유관(P＜0.05),이여성별、술후심률실상무현저성관계.(3)경Logistic회귀분석발현:술후광억소C≥1.02 mg/L、체질량≤5 kg화술후기항≥35.6 μmol/L시영유인체외순배심장술후발생AKI적독립위험인소,기풍험분별증가8.947、6.567화5.387배;ROC곡선하면적위0.937,제시예측AKI적민감성화특이성균교강.결론 (1)술전평고영유인CPB심장수술환자년령、체질량、술전광억소C저3항지표유조우발현고위인군;진가능축단수술시간,조건윤허시급조철제호흡궤,급시처리폐동맥고압화의원획득성폐염,술후감측기항화광억소C수평가재일정정도상감소술후AKI적발생.(2)림상상가근거술전체질량、술후광억소C수평이급술후기항수평예측CPB심장술후AKI,이기채취예방조시감소AKI적발생,개선환인예후.
Objective To identify the risk facts for acute kidney injury (AKI) in infants and young children after cardiac surgery with cardiopulmonary bypass (CPB).Methods Data of 161 patients aged ≤3 years undergoing CPB were reviewed retrospectively from September,2012 to January,2013.According to the definition of AKI,they were divided into two groups:AKI group and non-AKI group.After univariate analysis,a binary logistic regression analysis was used to evaluate the independent risk factors in AKI after CPB.The predictive capability of risk factors for AKI was estimated by using an area under the receiver operating characteristic (ROC) curve.Results (1) Of them,23 (14.3％) patients were subjected to AKI after cardiac surgery.(2) Univariate analysis showed that age,body weight,preoperative serum concentration of cystatin C,duration of CPB time,duration of aortic cross-clamp,postponed sternum closure,RACHS-1,postoperative serum creatinine (Scr),postoperative serum cystatin C,inotropic score(IS),postoperative mechanical ventilation time,postoperative pulmonary hypertension,and postoperative nosocomial pneumonia were related to the development of AKI (P ＜ 0.05).Logistic regression analysis showed that the independent risk factors for AKI were postoperative serum cystatin C ≥ 1.02 mg/L (Odd Ratio:8.947),body weight ≤ 5 kg (OR:6.567) and Scr ≥ 35.6 μmoL/L (OR:5.387).Value for the ROC curve was 0.937.Conclusions (1) High risk population might be found out through preoperative evaluation of age,body weight and serum cystatin C before CPB.(2) The present results strongly suggest that postoperative serum cystatin C,body weight and postoperative Scr are risk factors of AKI after CPB,thereby making reliable and early diagnosis and prognosis of AKI.