Colasacco Colby, Worthen Mike, Peterson Brad, Lamberti John, Spear Robert
Critical Care Medicine, Rady Children's Hospital San Diego, San Diego, CA, USA.
World J Pediatr Congenit Heart Surg. 2011 Oct 1;2(4):536-40. doi: 10.1177/2150135111411932.
Infants undergoing repair or palliation of congenital heart disease are at risk of renal insufficiency. Development of renal insufficiency increases mortality. This project seeks to determine whether intra- and postoperative renal near-infrared spectroscopy (NIRS) monitoring can reliably predict renal insufficiency after cardiac surgery in infants.
In this prospective, observational cohort study 48 patients undergoing repair or palliation of congenital heart disease in the first 6 months of life were studied intraoperatively and on postoperative day 1 and 2. The NIRS mean and nadir were recorded for the 3 time periods, as were urine output, fluid balance, and serum creatinine. Renal insufficiency was defined as rise in creatinine ≥40% from baseline or oliguria for >4 hours. Near-infrared spectroscopy data were compared to creatinine increase, oliguria, and fluid balance on postoperative day 0, 1, and 2 by regression analysis.
Mean renal regional saturation on postoperative day 1 has a strong correlation with increase in creatinine (P < .001 and R (2) = .6). Mean renal saturation less than 80% predicts renal insufficiency with a sensitivity of 100% and a specificity of 75% (P < .001).
Monitoring of intra- and postoperative renal regional saturation may provide an early, noninvasive marker of renal insufficiency after cardiac surgery in infants. This would be clinically significant if interventions to improve renal regional saturation prevent renal insufficiency.
接受先天性心脏病修复或姑息治疗的婴儿有发生肾功能不全的风险。肾功能不全的发生会增加死亡率。本项目旨在确定术中和术后肾脏近红外光谱（NIRS）监测能否可靠预测婴儿心脏手术后的肾功能不全。
在这项前瞻性观察队列研究中，对48例在出生后前6个月接受先天性心脏病修复或姑息治疗的患者进行术中及术后第1天和第2天的研究。记录这3个时间段的NIRS平均值和最低点，以及尿量、液体平衡和血清肌酐。肾功能不全定义为肌酐较基线水平升高≥40%或少尿超过4小时。通过回归分析比较术后第0、1和2天的近红外光谱数据与肌酐升高、少尿和液体平衡情况。
术后第1天的平均肾脏区域饱和度与肌酐升高密切相关（P <.001，R(2)=.6）。平均肾脏饱和度低于80%预测肾功能不全的敏感性为100%，特异性为75%（P <.001）。
术中和术后监测肾脏区域饱和度可能为婴儿心脏手术后肾功能不全提供一种早期、非侵入性的标志物。如果改善肾脏区域饱和度的干预措施能预防肾功能不全，这将具有临床意义。
