Sakai Wataru, Yoshikawa Yusuke, Hirata Naoyuki, Yamakage Michiaki
Department of Anesthesiology, Asahikawa City Hospital, Kinseicho 1-1-65, Asahikawa, Hokkaido, 070-8610, Japan.
Department of Anesthesiology, Sapporo Medical University Hospital, South 1, West 16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan.
J Anesth. 2017 Dec;31(6):895-902. doi: 10.1007/s00540-017-2419-y. Epub 2017 Oct 30.
Acute kidney injury (AKI) after cardiopulmonary bypass (CPB) is a well-known postoperative complication. Remifentanil, which is a commonly used ultra-short-acting opioid, has antiinflammatory and sympatholytic effects with improvement of microcirculation.
A retrospective study was conducted to clarify the effect of the use of remifentanil during CPB on the incidence of postoperative AKI. Patients who underwent valve surgery while under cardiopulmonary bypass between January 2012 and December 2014 in our hospital were enrolled in this study. The incidences of postoperative AKI were compared in patients who received remifentanil during CPB (group R) and those who did not (group N). Univariate and multivariate regression analyses were performed to determine risk factors for AKI.
Eighty patients received remifentanil (group R) and 50 patients did not (group N). The incidences of AKI were not significantly different in group R and group N (51% vs. 36%, P = 0.10). In multivariate regression analysis, age [adjusted odds ratio (OR) 1.048, 95% CI 1.008-1.089, P = 0.017], male gender (adjusted OR 3.101, 95% CI 1.303-7.378, P = 0.011), and use of preoperative calcium channel blockers (adjusted OR 3.240, 95% CI 1.302-8.063, P = 0.011) and diuretics (adjusted OR 2.673, 95% CI 1.178-6.066, P = 0.019) were associated with the incidence of AKI. The use of remifentanil was not associated with AKI (adjusted OR 2.321, 95% CI 0.997-5.402, P = 0.051).
The use of remifentanil during CPB did not decrease the incidence of postoperative AKI after cardiac surgery.
体外循环（CPB）后急性肾损伤（AKI）是一种众所周知的术后并发症。瑞芬太尼是一种常用的超短效阿片类药物，具有抗炎和抗交感神经作用，并能改善微循环。
进行一项回顾性研究，以阐明CPB期间使用瑞芬太尼对术后AKI发生率的影响。纳入2012年1月至2014年12月在我院接受体外循环下瓣膜手术的患者。比较CPB期间接受瑞芬太尼的患者（R组）和未接受瑞芬太尼的患者（N组）术后AKI的发生率。进行单因素和多因素回归分析以确定AKI的危险因素。
80例患者接受瑞芬太尼（R组），50例患者未接受（N组）。R组和N组的AKI发生率无显著差异（51%对36%，P = 0.10）。在多因素回归分析中，年龄[调整后的优势比（OR）1.048，95%置信区间（CI）1.008 - 1.089，P = 0.017]、男性（调整后的OR 3.101，95% CI 1.303 - 7.378，P = 0.011）以及术前使用钙通道阻滞剂（调整后的OR 3.240，95% CI 1.302 - 8.063，P = 0.011）和利尿剂（调整后的OR 2.673，95% CI 1.178 - 6.066，P = 0.019）与AKI的发生率相关。瑞芬太尼的使用与AKI无关（调整后的OR 2.321，95% CI 0.997 - 5.402，P = 0.051）。
CPB期间使用瑞芬太尼并未降低心脏手术后术后AKI的发生率。
