Pôle d'Anesthésie Réanimation, CHU d'Angers, Rue Larrey, 49933 Angers Cedex 9, France.
Br J Anaesth. 2011 Dec;107(6):891-8. doi: 10.1093/bja/aer289. Epub 2011 Sep 22.
Acute kidney injury (AKI) is common after cardiac surgery, affecting outcome. Early detection of an AKI marker is likely to speed diagnosis and implementation of measures to preserve renal function. In septic shock and unselected ventilated subjects, an increased Doppler renal resistive index (RRI) is a predictor of AKI. This study aims to determine whether RRI would act similarly in the postoperative setting of cardiac surgery.
This study included 65 subjects aged more than 60 yr undergoing elective heart surgery with cardiopulmonary bypass (CPB) and at risk of AKI. All presented at least one AKI risk factor [arteritis, diabetes, or serum creatinine (sCr) clearance of 30-60 ml min(-1)] and were haemodynamically stable without arrhythmia. Doppler RRI was measured in the immediate postoperative period (POP) while subjects were ventilated and sedated. AKI was assessed when sCr increased 30% above the preoperative baseline.
Eighteen subjects developed AKI between days 1 and 4, with six requiring dialysis. RRI in the POP was increased in AKI [RRI: 0.79 (0.08) with AKI vs 0.68 (0.06) without AKI, P<0.001], correlating to AKI severity [0.68 (0.06) without AKI, 0.77 (0.08) with AKI but no dialysis, and 0.84 (0.03) with AKI and dialysis, P<0.001]. RRI was similar in subjects receiving catecholamines. RRI >0.74 in the POP predicted delayed AKI with high sensitivity and specificity (0.85 and 0.94, respectively). Multivariate analysis showed that AKI was associated with increased RRI and transfusion.
RRI used in the immediate POP after cardiac surgery with CPB enabled prediction of delayed AKI and anticipation of its severity.
心脏手术后常发生急性肾损伤（AKI），影响预后。早期发现 AKI 标志物可能会加速诊断，并采取措施保护肾功能。在脓毒性休克和未选择的机械通气患者中，多普勒肾阻力指数（RRI）增加是 AKI 的预测指标。本研究旨在确定 RRI 在心脏手术后的围手术期是否具有相同作用。
本研究纳入了 65 名年龄大于 60 岁的择期行体外循环（CPB）心脏手术且存在 AKI 风险的患者。所有患者均存在至少一个 AKI 危险因素[动脉炎、糖尿病或血清肌酐（sCr）清除率 30-60 ml min(-1)]，血流动力学稳定且无心律失常。在术后即刻（POP）患者接受机械通气和镇静时测量多普勒 RRI。当 sCr 比术前基线升高 30%时，评估 AKI。
18 名患者在第 1 至 4 天发生 AKI，其中 6 名需要透析。POP 时 RRI 在 AKI 组中增加[RRI：0.79（0.08）伴 AKI vs 0.68（0.06）无 AKI，P<0.001]，与 AKI 严重程度相关[无 AKI 时为 0.68（0.06），伴 AKI 但无需透析时为 0.77（0.08），伴 AKI 且需要透析时为 0.84（0.03），P<0.001]。接受儿茶酚胺治疗的患者中 RRI 相似。POP 中 RRI>0.74 预测延迟性 AKI 具有高灵敏度和特异性（分别为 0.85 和 0.94）。多变量分析表明，AKI 与 RRI 增加和输血有关。
CPB 心脏手术后 POP 中使用 RRI 可预测延迟性 AKI 并预测其严重程度。
