血清肌酐和估算的肌酐清除率无法预测接受先天性心脏手术的新生儿围手术期测量的肌酐清除率。
Serum creatinine and estimated creatinine clearance do not predict perioperatively measured creatinine clearance in neonates undergoing congenital heart surgery.
作者信息
Harrison A Marc, Davis Steve, Eggleston Suzanne, Cunningham Robert, Mee Roger B B, Bokesch Paula M
机构信息
Department of Pediatric Critical Care Medicine, Children's Hospital, Cleveland Clinic, Cleveland, OH, USA.
出版信息
Pediatr Crit Care Med. 2003 Jan;4(1):55-9. doi: 10.1097/00130478-200301000-00011.
OBJECTIVE
To describe changes in creatinine clearance (CrCl) in a small group of neonates who underwent surgery for repair of transposition of the great arteries or palliation of hypoplastic left heart syndrome. To determine whether serum creatinine, urine output, or the Schwartz formula accurately predict measured CrCl in these patients.
DESIGN
Prospective, randomized controlled trial with subsequent extraction of information regarding renal function from the database.
SETTING
A 14-bed pediatric intensive care unit in a children's hospital.
PATIENTS
A total of 14 neonates (hypoplastic left heart syndrome, 6; transposition of the great arteries, 8).
MEASUREMENTS
Demographic information, urine output, serum creatinine, and 24-hr CrCl preoperatively and postoperatively on days 1 and 2.
MAIN RESULTS
Weight, age, and body surface area were 3.3 +/- 0.6 kg, 8.2 +/- 6.9 days, and 0.2 +/- 0.02 m2, respectively. Urine output increased from 1.8 +/- 0.5 mL x kg(-1) x hr(-1) preoperatively to 2.4 +/- 0.8 mL x kg(-1) x hr(-1) on postoperative day 1 (p = .02) and 2.8 +/- 1.1 mL x kg(-1) x hr(-1) on postoperative day 2 (p = .007). Serum creatinine changed from 0.64 +/- 0.15 mg/dL preoperatively to 0.72 +/- 0.40 mg/dL on postoperative day 1 (p = .4, not significant) to 0.78 +/- 0.41 mg/dL on postoperative day 2 (p = .17, not significant). Measured CrCl changed from 22.8 +/- 9.4 mL x min(-1) x 1.73 m(-2) preoperatively to 25.1 +/- 31 mL x min(-1) x 1.73 m(-2) on postoperative day 1 (p = .77, not significant) and 24.9 +/- 19.9 on postoperative day 2 (p = .69, not significant). No difference in measured CrCl was noted based on hypoplastic left heart syndrome vs. transposition of the great arteries. Median overestimation of CrCl by the Schwartz equation was 58% preoperatively, 78% on postoperative day 1, and 53% on postoperative day 2. Clinically significant correlations were not noted between measured CrCl and serum creatinine or urine production preoperatively, on postoperative day 1, or on postoperative day 2. Bland-Altman plot demonstrated that the Schwartz equation was a biased and imprecise estimate of CrCl at all three time points.
CONCLUSIONS
Perioperative CrCl is unpredictable in neonates with transposition of the great arteries and hypoplastic left heart syndrome. Serum creatinine, urine output, and the Schwartz formula do not accurately predict CrCl. Reliance on estimates of CrCl could result in toxic concentrations of drugs eliminated by the kidneys.
目的
描述一小群接受大动脉转位修复术或低体重左心综合征姑息手术的新生儿的肌酐清除率（CrCl）变化。确定血清肌酐、尿量或施瓦茨公式是否能准确预测这些患者的实测CrCl。
设计
前瞻性随机对照试验，随后从数据库中提取有关肾功能的信息。
地点
一家儿童医院的14张床位的儿科重症监护病房。
患者
共14名新生儿（低体重左心综合征6例；大动脉转位8例）。
测量指标
术前以及术后第1天和第2天的人口统计学信息、尿量、血清肌酐和24小时CrCl。
主要结果
体重、年龄和体表面积分别为3.3±0.6 kg、8.2±6.9天和0.2±0.02 m²。尿量从术前的1.8±0.5 mL·kg⁻¹·hr⁻¹增加到术后第1天的2.4±0.8 mL·kg⁻¹·hr⁻¹（p = 0.02）和术后第2天的2.8±1.1 mL·kg⁻¹·hr⁻¹（p = 0.007）。血清肌酐从术前的0.64±0.15 mg/dL变为术后第1天的0.72±0.40 mg/dL（p = 0.4，无显著差异），术后第2天变为0.78±0.41 mg/dL（p = 0.17，无显著差异）。实测CrCl从术前的22.8±9.4 mL·min⁻¹·1.73 m⁻²变为术后第1天的25.1±31 mL·min⁻¹·1.73 m⁻²（p = 0.77，无显著差异），术后第2天变为24.9±19.9（p = 0.69，无显著差异）。基于低体重左心综合征与大动脉转位，实测CrCl未发现差异。施瓦茨方程对CrCl的中位数高估在术前为58%，术后第1天为78%，术后第2天为53%。术前、术后第1天或术后第2天，实测CrCl与血清肌酐或尿量之间未发现临床显著相关性。布兰德-奥特曼图表明，施瓦茨方程在所有三个时间点对CrCl的估计都有偏差且不准确。
结论
大动脉转位和低体重左心综合征新生儿的围手术期CrCl不可预测。血清肌酐、尿量和施瓦茨公式不能准确预测CrCl。依赖CrCl估计值可能导致经肾脏排泄的药物达到中毒浓度。
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