Karim Habib Md Reazaul, Yunus Mohd, Saikia Manuj Kumar, Kalita Jyoti Prasad, Mandal Mrinal
Department of Anaesthesiology, Andaman and Nicobar Island Institute of Medical Sciences, Port Blair, India.
Department of Anaesthesiology and Critical Care, North Eastern Indira Gandhi Regional Institute of Medical and Health Sciences, Shillong, Meghalaya, India.
Ann Card Anaesth. 2017 Jan-Mar;20(1):22-27. doi: 10.4103/0971-9784.197823.
Cardiac surgery-associated kidney injury (CSA-AKI) is common but relatively less is known about its progression. The present study is aimed at evaluating the incidence and course of CSA-AKI and its relationship with the different durations of cardiopulmonary bypass (CPB) and cross clamp times.
Occurrences of CSA-AKI are evaluated as per the Akin Kidney Injury Network (AKIN) criteria over the course of 5 postoperative day (POD) in 100 patients. The relationship of different durations of CPB and aortic cross clamp time with CSA-AKI is analyzed by Chi-squared test for trend and other appropriate tests using INSTAT software.
One hundred (43 male, 57 female; mean age of 37.01 ± 12.28 years, and baseline mean serum creatinine 0.99 ± 0.20 mg %) patients undergone mostly valve replacement, and congenital heart disease correction was evaluated. Nearly 49% suffered CSA-AKI (81.63% AKIN Class I) with maximum numbers on 2 nd POD. Serum creatinine followed a falling trend 3 rd POD onward except in 8.16% cases of CSA-AKI. Oliguria was absent even in AKIN Class II. The CPB time >70 min and cross clamp time >60 min increase CSA-AKI risk by an OR of 4.76 and 2.84, respectively (P < 0.05).
CSA-AKI is very prevalent; mostly of AKIN Class I and increases with increasing CPB and cross clamp time. Urine output is not a reliable indicator of CSA-AKI. The AKIN Class II on the very 1 st POD or increasing trend of serum creatinine beyond 3 rd POD should alert for early intervention.
心脏手术相关肾损伤（CSA - AKI）很常见，但对其进展了解相对较少。本研究旨在评估CSA - AKI的发生率、病程及其与不同体外循环（CPB）时间和主动脉阻断时间的关系。
根据急性肾损伤网络（AKIN）标准，在100例患者术后5天内评估CSA - AKI的发生情况。使用INSTAT软件，通过趋势卡方检验和其他适当检验分析不同CPB时间和主动脉阻断时间与CSA - AKI的关系。
对100例患者（43例男性，57例女性；平均年龄37.01±12.28岁，基线平均血清肌酐0.99±0.20mg%）进行了评估，这些患者大多接受瓣膜置换术和先天性心脏病矫正手术。近49%的患者发生CSA - AKI（81.63%为AKIN I级），在术后第2天发生率最高。除8.16%的CSA - AKI病例外，血清肌酐从术后第3天起呈下降趋势。即使在AKIN II级患者中也无少尿情况。CPB时间>70分钟和主动脉阻断时间>60分钟时，CSA - AKI风险分别增加4.76倍和2.84倍（P<0.05）。
CSA - AKI非常普遍；大多为AKIN I级，且随着CPB时间和主动脉阻断时间的增加而增加。尿量不是CSA - AKI的可靠指标。术后第1天出现AKIN II级或术后第3天血清肌酐呈上升趋势应警惕早期干预。
