Bristol Royal Hospital for Children, University of Bristol, Bristol, United Kingdom.
J Thorac Cardiovasc Surg. 2011 Nov;142(5):1114-21, 1121.e1-2. doi: 10.1016/j.jtcvs.2011.08.008. Epub 2011 Aug 26.
Hypothermic cardiopulmonary bypass (CPB), although associated with a reduction in oxygen requirement, has a number of disadvantages including detrimental effects on enzymatic function, energy generation, and cellular integrity. Normothermic perfusion is potentially a more physiologic method to maintain the functional integrity of major organ systems. One of the aims of this trial was to compare the effect of normothermic and hypothermic CPB on renal injury in pediatric patients undergoing cardiac surgery.
Fifty-nine children (median age, 78 months; interquartile range, 39-130) undergoing corrective cardiac surgery were randomized to either hypothermic (28°C) or normothermic (35°C-37°C) CPB. Urinary albumin, retinal binding protein (RBP) and N-acetyl-β-glucosaminidase (NAG) were measured preoperatively, end of CPB, 4, and 24 hours postoperatively and were expressed as a ratio of urinary creatinine. Serum creatinine was measured preoperatively, end of CPB, and 24 and 48 hours postoperatively. Results are expressed as a difference in means (normotheric - hypothermic) or as a ratio of geometric means (normothermic/hypothermic).
Baseline characteristics were similar in both groups. For these biochemical markers no significant interactions between treatment and postintervention time were found. Serum creatinine (-2.10; 95% confidence interval [CI], -6.51-2.31), RBP (ratio, 0.96; 95% CI, 0.65-1.41), and NAG (ratio, 0.86; 95% CI, 0.56-1.36) were similar in the 2 groups (P ≥ .34), but the urinary albumin was significantly lower in the normothermic group (ratio, 0.63; 95% CI, 0.42-0.95, P = .03).
Normothermic CPB is associated with similar renal impairment to hypothermic CPB in children undergoing heart surgery.
低温体外循环（CPB）虽然可降低氧需求，但存在许多缺点，包括对酶功能、能量产生和细胞完整性产生不利影响。常温灌注可能是维持主要器官系统功能完整性的更生理方法。本试验的目的之一是比较常温与低温 CPB 对接受心脏手术的儿科患者肾损伤的影响。
59 名（中位年龄，78 个月；四分位距，39-130）接受矫正性心脏手术的儿童随机分为低温（28°C）或常温（35°C-37°C）CPB 组。术前、CPB 结束时、术后 4 小时和 24 小时测量尿白蛋白、视网膜结合蛋白（RBP）和 N-乙酰-β-氨基葡萄糖苷酶（NAG），并以尿肌酐的比值表示。术前、CPB 结束时和术后 24 小时和 48 小时测量血清肌酐。结果表示为均值差值（常温-低温）或几何均数比值（常温/低温）。
两组的基线特征相似。对于这些生化标志物，未发现治疗与术后时间之间存在显著交互作用。两组的血清肌酐（-2.10；95%置信区间[CI]，-6.51-2.31）、RBP（比值，0.96；95%CI，0.65-1.41）和 NAG（比值，0.86；95%CI，0.56-1.36）相似（P≥.34），但常温组的尿白蛋白明显较低（比值，0.63；95%CI，0.42-0.95，P=0.03）。
常温 CPB 与低温 CPB 在心内直视手术患儿中引起相似的肾损伤。
