Lombardi Raúl, Ferreiro Alejandro, Servetto Cristina
Department of Critical Care Medicine, IMPASA, Montevideo, Uruguay.
Ren Fail. 2003 Sep;25(5):775-86. doi: 10.1081/jdi-120024293.
Renal failure is a frequent event after cardiopulmonary by-pass. Hemodynamic alterations that occur during surgery, as well as factors depending on the host, are the main risk factors for renal dysfunction. To evaluate the frequency and risk factors for renal dysfunction in this setting, a cohort of fifty patients with preoperative serum creatinine under 1.5 mg/dL, submitted to cardiac surgery with cardiopulmonary by-pass was analyzed. Variables related to preoperative patient condition, intraoperative and postoperative periods were recorded. Renal function was assessed by clearances of creatinine, urea and free water, also by fractional excretion of sodium (FENa), at baseline, at anesthetic induction and during postoperative period. Patients were arbitrarily divided in two groups, according to the serum creatinine (S(Cr)) value at the end of the postoperative period: Group 1: S(Cr) < 2 mg/dL (n = 44 patients (88.5%)) and Group II: S(Cr) > 2 mg/dL (n = 6 patients (11.5%)). A decrease of renal function was observed in all patients: creatinemia raised from 1.04 +/- 0.2 to 1.55 +/- 0.4 mg/dL (33%), associated with a rise in FENa. Differences between group I and group II using univariate analysis were: baseline serum creatinine (1.01 +/- 0.23 mg/dL vs. 1.26 +/- 0.19 mg/dL, p = 0.03), FENa (0.99 +/- 0.8 vs. 2.2 +/- 2.1, p = 0.04), furosemide dose during surgery normalized to body surface area (93.2 +/- 23 mg/1.73 m2 BSA vs. 135 +/- 38 mg/1.73 m2 BSA, p < 0.001), and hemodilution index (17.3 +/- 4.3% vs. 22.8 +/- 3.2%, p < 0.01). In the multiple regression model, baseline creatinemia and furosemide dose were associated to renal dysfunction.
肾衰竭是体外循环心脏手术后的常见情况。手术期间发生的血流动力学改变以及宿主相关因素是肾功能不全的主要危险因素。为了评估这种情况下肾功能不全的发生率和危险因素，我们分析了一组50例术前血清肌酐低于1.5mg/dL、接受体外循环心脏手术的患者。记录了与术前患者状况、术中和术后相关的变量。在基线、麻醉诱导时和术后期间，通过肌酐清除率、尿素清除率和自由水清除率以及尿钠排泄分数（FENa）评估肾功能。根据术后血清肌酐（S(Cr)）值，患者被随机分为两组：第1组：S(Cr)<2mg/dL（n = 44例患者（88.5%））和第II组：S(Cr)>2mg/dL（n = 6例患者（11.5%））。所有患者均出现肾功能下降：血肌酐从1.04±0.2mg/dL升至1.55±0.4mg/dL（33%），同时FENa升高。单因素分析显示，第I组和第II组之间的差异为：基线血清肌酐（1.01±0.23mg/dL对1.26±0.19mg/dL，p = 0.03）、FENa（0.99±0.8对2.2±2.1，p = 0.04）、手术期间按体表面积标准化的呋塞米剂量（93.2±23mg/1.73m2体表面积对135±38mg/1.73m2体表面积，p<0.001）以及血液稀释指数（17.3±4.3%对22.8±3.2%，p<0.01）。在多元回归模型中，基线血肌酐和呋塞米剂量与肾功能不全相关。
