Gaffney Alan M, Sladen Robert N
Department of Anesthesiology, College of Physicians and Surgeons of Columbia University, New York, USA.
Curr Opin Anaesthesiol. 2015 Feb;28(1):50-9. doi: 10.1097/ACO.0000000000000154.
Acute kidney injury (AKI) is a long-recognized complication of cardiac surgery. It is a commonly encountered clinical syndrome that, in its most severe form, increases the odds of operative mortality three to eight-fold. The pathogenesis of cardiac surgery-associated acute kidney injury (CSA-AKI) is complex. No single intervention is likely to provide a panacea, and thus, the purpose of this review is to assess the wide breadth of emerging research into potential strategies to prevent, diagnose, and treat CSA-AKI.
Research in the field of CSA-AKI published within the last 18 months adds further layers of knowledge to many previously studied areas. These include its definition (Risk, Injury, Failure, Loss, End-stage kidney disease, Acute Kidney Injury Network, and Kidney Disease: Improving Global Outcomes criteria), diagnosis (biomarkers and intraoperative renal oximetry), prevention (statin therapy, acetylsalicylic acid, N-acetylcysteine, sodium bicarbonate, off-pump coronary revascularization, goal-directed hemodynamic therapy, and minimizing blood transfusion), and treatment (early initiation of renal replacement therapy).
Although there has been much high-quality research conducted in this field in recent years, preventing CSA-AKI by avoiding renal insults remains the mainstay of management. Although biomarkers have the potential to diagnose CSA-AKI at an earlier stage, efficacious interventions to treat established CSA-AKI remain elusive.
急性肾损伤（AKI）是心脏手术一种早已被认识的并发症。它是一种常见的临床综合征，在最严重的情况下，手术死亡率会增加三到八倍。心脏手术相关急性肾损伤（CSA-AKI）的发病机制很复杂。没有单一的干预措施可能是万灵药，因此，本综述的目的是评估对预防、诊断和治疗CSA-AKI的潜在策略的广泛新兴研究。
过去18个月内发表的关于CSA-AKI领域的研究为许多先前研究的领域增加了更多知识层面。这些包括其定义（风险、损伤、衰竭、丧失、终末期肾病、急性肾损伤网络和改善全球肾脏病预后组织标准）、诊断（生物标志物和术中肾脏血氧测定）、预防（他汀类药物治疗、乙酰水杨酸、N-乙酰半胱氨酸、碳酸氢钠、非体外循环冠状动脉血运重建、目标导向血流动力学治疗和尽量减少输血）以及治疗（早期开始肾脏替代治疗）。
尽管近年来该领域进行了大量高质量研究，但通过避免肾脏损伤来预防CSA-AKI仍然是主要的管理方法。虽然生物标志物有可能在更早阶段诊断CSA-AKI，但治疗已确诊的CSA-AKI的有效干预措施仍然难以捉摸。
