Ranucci Marco, Soro Giorgio, Barzaghi Nicoletta, Locatelli Alessandro, Giordano Gianbeppe, Vavassori Angelo, Manzato Aldo, Melchiorri Chiara, Bove Tiziana, Juliano Glauco, Uslenghi Maria Francesca
Cardiothoracic Anesthesia and Intensive Care, Istituto Policlinico S. Donato, Milan, Italy.
Ann Thorac Surg. 2004 Oct;78(4):1332-7; discussion 1337-8. doi: 10.1016/j.athoracsur.2004.02.065.
Acute renal failure requiring replacement therapy occurs in 1% to 2% of patients who have undergone cardiac surgery with cardiopulmonary bypass and is associated with a very high mortality rate. The aim of this study was to determine if prophylactic treatment with fenoldopam mesylate of patients at high risk of postoperative acute renal failure reduced the incidence of this event.
This was a multicenter, prospective, cohort study in which 108 patients at high risk of postoperative acute renal failure and undergoing cardiac surgery with cardiopulmonary bypass were treated with fenoldopam mesylate (0.08 microg x kg(-1) x min(-1)) starting at the induction of anesthesia and throughout at least the next 24 hours. A homogeneous control group of 108 patients was created using a propensity-score analysis.
Fenoldopam prophylaxis was significantly associated with a reduction in acute renal failure incidence (from 22% to 11%, p = 0.028), a less pronounced creatinine clearance decrease (p = 0.05), and a lower mortality rate (6.5% versus 15.7%, p = 0.03) by the univariate analysis, but these results were not confirmed by a multivariable analysis. Within the subgroup of patients who suffered a postoperative low output syndrome, fenoldopam prophylaxis was an independent protective factor for postoperative renal failure (odds ratio, 0.14; 95% confidence interval, 0.03 to 0.7; p = 0.017).
Given the limitations of a nonrandomized prospective trial, our results support the hypothesis that fenoldopam may reduce the risk of acute renal failure in patients in whom endogenous and exogenous cathecolamines action may induce a renal vascular constrictive condition.
需要进行替代治疗的急性肾衰竭发生于1%至2%接受体外循环心脏手术的患者中，且与极高的死亡率相关。本研究的目的是确定对术后急性肾衰竭高危患者使用甲磺酸非诺多泮进行预防性治疗是否能降低该事件的发生率。
这是一项多中心、前瞻性队列研究，108例术后急性肾衰竭高危且接受体外循环心脏手术的患者从麻醉诱导开始并在至少接下来的24小时内接受甲磺酸非诺多泮（0.08微克×千克⁻¹×分钟⁻¹）治疗。使用倾向评分分析创建了一个由108例患者组成的同质对照组。
单因素分析显示，甲磺酸非诺多泮预防与急性肾衰竭发生率降低（从22%降至11%，p = 0.028）、肌酐清除率下降不那么明显（p = 0.05）以及死亡率降低（6.5%对15.7%，p = 0.03）显著相关，但多变量分析未证实这些结果。在术后低输出综合征患者亚组中，甲磺酸非诺多泮预防是术后肾衰竭的独立保护因素（比值比，0.14；95%置信区间，0.03至0.7；p = 0.017）。
鉴于非随机前瞻性试验的局限性，我们的结果支持以下假设：甲磺酸非诺多泮可能降低内源性和外源性儿茶酚胺作用可能诱发肾血管收缩状态的患者发生急性肾衰竭的风险。
