Kumar T K Susheel, Allen Ccp Jerry, Spentzas Md Thomas, Berrios Ccp Lindsay, Shah Md Samir, Joshi Md Vijaya M, Ballweg Md Jean A, Knott-Craig Md Christopher J
Department of Pediatric Cardiothoracic Surgery, LeBonheur Children's Hospital and University of Tennessee, Memphis, TN, USA
Department of Pediatric Cardiothoracic Surgery, LeBonheur Children's Hospital and University of Tennessee, Memphis, TN, USA.
World J Pediatr Congenit Heart Surg. 2016 Jul;7(4):460-6. doi: 10.1177/2150135116648305.
Acute kidney injury (AKI) following cardiac surgery is a serious complication with a reported incidence of 30% to 50%. This study sought to determine the prevalence and risk factors for AKI among neonates and young infants undergoing repair of cardiac defects at an institution using novel perioperative strategies.
A retrospective analysis of 102 consecutive infants (<2 months) undergoing repair of cardiac defects on cardiopulmonary bypass formed the study group. Cardiac diagnoses were stratified according to the Society of Thoracic Surgeons Congenital Heart Surgery (STAT) mortality categories. The prevalence of AKI within 72 hours was defined according to the three-stage Acute Kidney Injury Network criteria. Novel bypass strategies to preserve renal function included maintenance of higher hematocrit and high flow rates on cardiopulmonary bypass despite systemic hypothermia, and avoidance of albumin and milrinone in the perioperative period.
Mean age was 24 ± 19 days. Eighteen patients were less than 7 days of age at the time of surgery. Patient distribution according to STAT categories was as follows: 1 (n = 21), 2 (n = 12), 3 (n = 22), 4 (n = 28), and 5 (n = 19). The incidence of stages 1, 2, and 3 AKI in the population was 8% (n = 9), 2% (n = 2), and 0% (n = 0), respectively. On multivariate analysis higher STAT category was the only significant risk factor for AKI.
Current incidence of AKI following cardiac surgery in young infants at our institution is low. Novel perioperative strategies may have contributed to the low observed incidence of AKI in our patient population. Increased complexity of heart disease was a risk factor for AKI.
心脏手术后发生的急性肾损伤（AKI）是一种严重并发症，报告发病率为30%至50%。本研究旨在确定在一家采用新型围手术期策略的机构中，接受心脏缺陷修复手术的新生儿和小婴儿中AKI的患病率及危险因素。
对102例连续接受体外循环心脏缺陷修复手术的婴儿（<2个月）进行回顾性分析，构成研究组。根据胸外科医师协会先天性心脏病手术（STAT）死亡率类别对心脏诊断进行分层。根据急性肾损伤网络的三阶段标准定义72小时内AKI的患病率。新型体外循环策略以保护肾功能，包括在全身低温情况下维持较高的血细胞比容和体外循环高流量，以及在围手术期避免使用白蛋白和米力农。
平均年龄为24±19天。18例患者在手术时年龄小于7天。根据STAT类别划分的患者分布如下：1类（n = 21）、2类（n = 12）、3类（n = 22）、4类（n = 28）和5类（n = 19）。该人群中1期、2期和3期AKI的发生率分别为8%（n = 9）、2%（n = 2）和0%（n = 0）。多因素分析显示，较高的STAT类别是AKI的唯一显著危险因素。
在我们机构中，小婴儿心脏手术后当前AKI的发生率较低。新型围手术期策略可能导致了我们患者群体中观察到的AKI低发生率。心脏病复杂性增加是AKI的一个危险因素。
