Aronson Solomon, Phillips-Bute Barbara, Stafford-Smith Mark, Fontes Manuel, Gaca Jeffrey, Mathew Joseph P, Newman Mark F
Department of Anesthesiology, Duke University Medical Center (DUMC) P.O. Box 3094, Baker House, Rm. 101, Durham, NC 27710, USA.
Anesthesiol Res Pract. 2013;2013:174091. doi: 10.1155/2013/174091. Epub 2013 Nov 14.
Background. Postoperative acute kidney injury (AKI) is associated with high mortality and substantial cost after aortocoronary bypass graft (CABG) surgery. We tested the hypothesis that intraoperative systolic blood pressure variation is associated with postoperative AKI. Methods. We gathered demographic, procedural, blood pressure, and renal outcome data for 7,247 CABG surgeries at a single institution between 1996 and 2005. A development/validation cohort methodology was randomly divided (66% and 33%, resp.). Peak postoperative serum creatinine rise relative to baseline (%ΔCr) was the primary AKI outcome variable. Markers reflective of intraoperative systolic blood pressure variation were derived for each patient including (1) peak and nadir values (absolute and relative to baseline) and (2) excursion episodes beyond selected thresholds (by duration, frequency, and duration × degree). Each marker of systolic blood pressure variation was then separately evaluated for association with AKI using linear regression models with adjustment for several known risk factors (age, aprotinin use, congestive heart failure, previous myocardial infarction, baseline creatinine, bypass time, diabetes, weight, concomitant valve surgery, gender, and preoperative pulse pressure). Results. An association was identified between systolic blood pressure relative to baseline and postoperative AKI (P < 0.006). Conclusions. In CABG surgery patients, intraoperative systolic blood pressure decrease relative to baseline systolic blood pressure is independently associated with postoperative AKI.
背景。术后急性肾损伤（AKI）与主动脉冠状动脉搭桥术（CABG）后的高死亡率和高昂成本相关。我们检验了术中收缩压变异性与术后AKI相关的假设。方法。我们收集了1996年至2005年间在单一机构进行的7247例CABG手术的人口统计学、手术过程、血压和肾脏结局数据。采用开发/验证队列方法进行随机划分（分别为66%和33%）。术后血清肌酐相对于基线的峰值升高（%ΔCr）是主要的AKI结局变量。为每位患者得出反映术中收缩压变异性的指标，包括（1）峰值和谷值（绝对值及相对于基线的值）以及（2）超过选定阈值的波动事件（按持续时间、频率以及持续时间×幅度）。然后，使用线性回归模型，在对几个已知危险因素（年龄、抑肽酶使用、充血性心力衰竭、既往心肌梗死、基线肌酐、搭桥时间、糖尿病、体重、同期瓣膜手术、性别和术前脉压）进行调整后，分别评估每个收缩压变异性指标与AKI的相关性。结果。确定了相对于基线的收缩压与术后AKI之间存在关联（P < 0.006）。结论。在CABG手术患者中，相对于基线收缩压的术中收缩压降低与术后AKI独立相关。
