Department of Pediatrics, PGIMER and Associated RML Hospital, New Delhi 110001, India.
Clin Exp Nephrol. 2011 Aug;15(4):529-34. doi: 10.1007/s10157-011-0440-2. Epub 2011 Apr 12.
To investigate the incidence, implicating factors and outcome of acute kidney injury (AKI) after cardiopulmonary bypass (CPB) in patients admitted to a pediatric cardiothoracic intensive care unit (ICU).
A retrospective review study.
A 10-bed cardiothoracic ICU.
One hundred and twenty-four children (<18 years of age) admitted to the cardiothoracic ICU following CPB between January 2007 and December 2009.
Age, sex, diagnosis, baseline and post-surgery hemoglobin, total leukocyte count, platelet count and biochemistry were recorded. Baseline and postoperative urea (mg/dl), creatinine (mg/dl), urine output (ml/kg/h) and inotrope dose were also recorded daily. The duration of CPB was noted. Postoperative cardiac, renal, hepatic, neurologic and respiratory dysfunctions were recorded.
Seven (5%) children developed AKI stage I, five children (4%) developed AKI stage II and two children developed AKI stage III (2%). All patients with AKI had a longer stay in hospital and increased mortality. Two children required dialysis for AKI and none developed chronic renal impairment. All patients with AKI stage III died during the ICU stay. Using stepwise regression, younger age (<1 year), weight <10 kg, pump failure, sepsis and duration of CPB >90 min were significant risk factors identified for developing AKI.
AKI is common and occurred in 11% of our patients following CPB; however, AKI requiring renal replacement therapy is uncommon.
调查体外循环（CPB）后入住儿科心胸重症监护病房（ICU）的患者发生急性肾损伤（AKI）的发生率、相关因素和结果。
回顾性研究。
10 张床位的心胸 ICU。
2007 年 1 月至 2009 年 12 月期间在 CPB 后入住心胸 ICU 的 124 名儿童（<18 岁）。
记录年龄、性别、诊断、基线和手术后的血红蛋白、总白细胞计数、血小板计数和生化指标。还记录了基线和术后的尿素（mg/dl）、肌酐（mg/dl）、尿量（ml/kg/h）和正性肌力药剂量，每天记录一次。记录 CPB 的持续时间。术后记录心脏、肾脏、肝脏、神经和呼吸系统功能障碍。
7 名（5%）儿童发生 AKI Ⅰ期，5 名（4%）儿童发生 AKI Ⅱ期，2 名（2%）儿童发生 AKI Ⅲ期。所有 AKI 患者的住院时间延长，死亡率增加。2 名 AKI 患者需要透析治疗，均未发生慢性肾功能不全。所有 AKI Ⅲ期患者在 ICU 期间死亡。使用逐步回归分析，年龄较小（<1 岁）、体重<10kg、泵衰竭、败血症和 CPB 持续时间>90 分钟是发生 AKI 的显著危险因素。
AKI 很常见，在我们的 CPB 后患者中发生率为 11%；然而，需要肾脏替代治疗的 AKI 并不常见。
