Department of Anesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education & Research, Dhanvantari Nagar, Pondicherry, India.
J Anesth. 2013 Jun;27(3):433-46. doi: 10.1007/s00540-012-1523-2. Epub 2012 Nov 22.
Cardiac surgery-associated acute kidney injury (AKI) is a major health problem that is extremely common and has a significant effect on cardiac surgical outcomes. AKI occurs in nearly 30 % of patients undergoing cardiac surgery, with about 1-2 % of these ultimately requiring dialysis. The development of AKI predicts a significant increase in morbidity and mortality independent of other risk factors. The pathogenetic mechanisms associated with cardiac surgery-associated AKI include several biochemical pathways, of which the most important are hemodynamic, inflammatory and nephrotoxic factors. Risk factors for AKI have been identified in several models, and these facilitate physicians to prognosticate and develop a strategy for tackling patients predisposed to developing renal dysfunction. Effective therapy of the condition is still suboptimal, and hence the accent has always been on risk factor modification. Thus, strategies for reducing preoperative anemia, perioperative blood transfusions and surgical re-explorations may be effective in attenuating the incidence and severity of this complication.
心脏手术相关的急性肾损伤（AKI）是一个严重的健康问题，它非常普遍，对心脏手术的结果有重大影响。AKI 几乎发生在 30%接受心脏手术的患者中，其中约 1-2%的患者最终需要透析。AKI 的发生独立于其他危险因素预测发病率和死亡率的显著增加。与心脏手术相关的 AKI 相关的发病机制包括几个生化途径，其中最重要的是血流动力学、炎症和肾毒性因素。AKI 的危险因素已在几种模型中确定，这些模型有助于医生预测并制定针对易发生肾功能障碍的患者的策略。该病症的有效治疗方法仍然不尽如人意，因此重点一直放在危险因素的改变上。因此，减少术前贫血、围手术期输血和再次手术的策略可能有助于减轻这种并发症的发生率和严重程度。
