Vascular Surgery, Università Vita-Salute, San Raffaele Scientific Institute, Milan, Italy.
Vascular Surgery, Università Vita-Salute, San Raffaele Scientific Institute, Milan, Italy.
J Vasc Surg. 2014 Mar;59(3):623-33. doi: 10.1016/j.jvs.2013.09.055. Epub 2013 Dec 28.
To determine whether renal perfusion with cold crystalloid solution enriched with histidine-tryptophan-ketoglutarate (Custodiol; Dr Franz-Kohler Chemie GmbH, Bensheim, Germany) provides better protection against renal ischemic injury than cold lactated Ringer's solution in patients undergoing thoracoabdominal aortic aneurysm open repair.
We analyzed a prospectively compiled database containing all 111 consecutive patients who underwent thoracoabdominal aortic aneurysm open repair at our center from 2008 to 2011. A cohort of 104 consecutive patients was identified of which 50 (48%) had renal perfusion with Custodiol and 54 (52%) with lactated Ringer's solution. Propensity score matching based on baseline clinical variables, which were expected to influence renal outcomes, was performed to correct for any bias that may have been associated with the use of Custodiol. Acute kidney injury (AKI) as defined by Kidney Disease Improving Global Outcomes guidelines and perioperative estimated glomerular filtration rate were compared in the two groups. Independent predictors of AKI were also identified by multivariate analysis.
After propensity score matching, we were able to match 42 Custodiol cases one-to-one with those receiving perfusion with lactated Ringer's solution. Overall 30-day mortality was 5.9%; temporary hemodialysis or continuous veno-venous hemofiltration was needed in 4.8% of the patients without any case of dialysis at discharge. Freedom from AKI was significantly increased in the Custodiol group (38.1% vs 9.5%; P = .002) despite longer total renal ischemic time (51.5 ± 16.4 minutes vs 43.6 ± 16.0 minutes; P = .05). By analysis of variance for repeated measures, a significant upward trend of perioperative estimated glomerular filtration rate was observed in the Custodiol group (group × time interaction = F3,66; P < .001), and by multivariate analysis, Custodiol perfusion was the only independent predictor of non-AKI (P = .04).
The use of Custodiol was safe and provided improved perioperative renal function compared with lactated Ringer's solution. Randomized trials are needed to confirm these data and to assess their clinical consequences.
为了确定在接受胸腹主动脉瘤开放修复的患者中，与冷乳酸林格氏液相比，富含组氨酸-色氨酸-酮戊二酸的冷晶体液（Custodiol；Dr Franz-Kohler Chemie GmbH，德国本斯海姆）的肾脏灌注是否能提供更好的肾脏缺血性损伤保护。
我们分析了一个前瞻性汇编的数据库，其中包含了 2008 年至 2011 年期间在我们中心接受胸腹主动脉瘤开放修复的 111 例连续患者。确定了一个由 104 例连续患者组成的队列，其中 50 例（48%）接受 Custodiol 灌注，54 例（52%）接受乳酸林格氏液灌注。根据可能影响肾脏结果的基线临床变量进行倾向评分匹配，以纠正可能与使用 Custodiol 相关的任何偏差。在两组之间比较了根据肾脏疾病改善全球结果指南定义的急性肾损伤（AKI）和围手术期估计肾小球滤过率。还通过多变量分析确定 AKI 的独立预测因素。
在进行倾向评分匹配后，我们能够将 42 例 Custodiol 病例与接受乳酸林格氏液灌注的病例一一匹配。总的 30 天死亡率为 5.9%；需要临时血液透析或连续静脉-静脉血液滤过的患者为 4.8%，出院时无透析患者。尽管总肾缺血时间更长（51.5±16.4 分钟 vs 43.6±16.0 分钟；P=0.05），但 Custodiol 组的 AKI 发生率显著升高（38.1% vs 9.5%；P=0.002）。通过重复测量方差分析，Custodiol 组观察到围手术期估计肾小球滤过率的显著上升趋势（组×时间交互作用= F3,66；P<0.001），通过多变量分析，Custodiol 灌注是 AKI 的唯一独立预测因素（P=0.04）。
与乳酸林格氏液相比，Custodiol 的使用是安全的，并提供了更好的围手术期肾功能。需要进行随机试验来证实这些数据，并评估其临床后果。
