Heringlake Matthias, Heinze Hermann, Schubert Maria, Nowak Yvonne, Guder Janina, Kleinebrahm Maria, Paarmann Hauke, Hanke Thorsten, Schön Julika
Crit Care. 2012 Aug 16;16(4):R156. doi: 10.1186/cc11476.
Cardiac-surgery-associated-acute-kidney-injury (CSA-AKI) is associated with increased morbidity and mortality. Recent data from patients undergoing on-pump coronary artery bypass grafting suggest that a perioperative infusion of sodium-bicarbonate may decrease the incidence of CSA-AKI. The present study aims to analyze the renoprotective effects of a 24h infusion of sodium-bicarbonate in a large, heterogeneous group of cardiac surgical patients
Starting in 4/2009, all patients undergoing cardiac surgery at our institution were enrolled in a prospective trial analyzing the relationship between preoperative cerebral oxygen saturation and postoperative organ dysfunction. We used this prospectively sampled data set to perform a cohort analysis of the renoprotective efficiency of a 24h continuous perioperative infusion of sodium-bicarbonate on the incidence of CSA-AKI that was routinely introduced in 7/2009. After exclusion of patients with endstage chronic kidney disease, off-pump procedures, and emergency cases, perioperative changes in renal function were assessed in 280 patients treated with a perioperative infusion of 4 mmol sodium-bicarbonate / kg body weight in comparison with a control cohort of 304 patients enrolled from April to June in this prospective cohort study.
With the exception of a lower prevalence of a history of myocardial infarction and a lower preoperative use of intravenous heparin in the bicarbonate-group, no significant between group differences in patient demographics, surgical risk, type, and duration of surgery were observed. Patients in the bicarbonate group had a lower mean arterial blood pressure after induction of anesthesia, needed more fluids, more vasopressors, and a longer treatment time in the high dependency unit. Despite a higher postoperative diuresis, no differences in the incidence of AKI grade 1 to 3 and the need for renal replacement were observed.
Routine perioperative administration of sodium bicarbonate failed to improve postoperative renal function in a large population of cardiac surgical patients.
心脏手术相关急性肾损伤（CSA-AKI）与发病率和死亡率增加相关。来自接受体外循环冠状动脉搭桥术患者的最新数据表明，围手术期输注碳酸氢钠可能会降低CSA-AKI的发生率。本研究旨在分析在一大组异质性心脏手术患者中24小时输注碳酸氢钠的肾脏保护作用。
从2009年4月开始，我们机构所有接受心脏手术的患者都被纳入一项前瞻性试验，分析术前脑氧饱和度与术后器官功能障碍之间的关系。我们使用这个前瞻性采样数据集，对2009年7月常规引入的围手术期24小时持续输注碳酸氢钠对CSA-AKI发生率的肾脏保护效率进行队列分析。在排除终末期慢性肾病患者、非体外循环手术患者和急诊病例后，将280例接受围手术期输注4 mmol碳酸氢钠/千克体重治疗的患者的肾功能围手术期变化与该前瞻性队列研究中4月至6月纳入的304例对照队列患者进行比较。
除了碳酸氢钠组心肌梗死病史患病率较低和术前静脉使用肝素较少外，未观察到两组在患者人口统计学、手术风险、类型和手术持续时间方面的显著差异。碳酸氢钠组患者在麻醉诱导后平均动脉血压较低，需要更多液体、更多血管升压药，在高依赖病房的治疗时间更长。尽管术后尿量增多，但在1至3级急性肾损伤的发生率和肾脏替代治疗需求方面未观察到差异。
在大量心脏手术患者中，围手术期常规给予碳酸氢钠未能改善术后肾功能。
