Duan Lian, Hu Guo-Huang, Jiang Meng, Zhang Cheng-Liang
Department of Cardiovascular Surgery, Xiangya Hospital, Central South University, Changsha 410008, China.
Zhongguo Dang Dai Er Ke Za Zhi. 2017 Nov;19(11):1196-1201. doi: 10.7499/j.issn.1008-8830.2017.11.014.
To analyze the perioperative clinical data of children with congenital heart disease complicated by acute kidney injury (AKI) after cardiopulmonary bypass (CPB) surgery, and to explore potential factors influencing the prognosis.
A retrospective analysis was performed among 118 children with congenital heart disease who developed AKI within 48 hours after CPB surgery.
In the 118 patients, 18 died after 48 hours of surgery. Compared with the survivors, the dead children had significantly higher incidence of cyanotic disease and Risk Adjustment for Congenital Heart Surgery-1 (RACHS-1) scores before surgery; during surgery, the dead children had significantly longer CPB time and aortic cross-clamping time, a significantly higher proportion of patients receiving crystalloid solution for myocardial protection, and a significantly higher mean blood glucose level. Within 48 hours after surgery, the dead children had significantly higher positive inotropic drug scores, significantly higher creatinine values, a significantly higher incidence of stage 3 AKI, a significantly higher proportion of patients receiving renal replacement the, and significantly higher usage of blood products (P<0.05). The mortality rate of the patients increased with increased intraoperative blood glucose levels (P<0.05). Patients with intraoperative blood glucose levels >8.3 mmol/L had a significantly lower postoperative cumulative survival rate and a significantly shorter mean survival time than those with blood glucose levels ≤ 8.3 mmol/L (P<0.05).
Intraoperative blood glucose levels are associated with the prognosis in children with congenital heart disease complicated by AKI after CPB surgery. Maintaining good intraoperative blood glucose control can improve the prognosis of the children.
分析先天性心脏病患儿体外循环（CPB）手术后并发急性肾损伤（AKI）的围手术期临床资料，探讨影响预后的潜在因素。
对118例CPB手术后48小时内发生AKI的先天性心脏病患儿进行回顾性分析。
118例患者中，18例在术后48小时后死亡。与存活者相比，死亡患儿术前青紫型疾病发生率和先天性心脏病手术风险调整-1（RACHS-1）评分显著更高；手术期间，死亡患儿CPB时间和主动脉阻断时间显著更长，接受晶体液心肌保护的患者比例显著更高，平均血糖水平显著更高。术后48小时内，死亡患儿正性肌力药物评分显著更高，肌酐值显著更高，3期AKI发生率显著更高，接受肾脏替代治疗的患者比例显著更高，血液制品使用量显著更高（P<0.05）。患者死亡率随术中血糖水平升高而增加（P<0.05）。术中血糖水平>8.3 mmol/L的患者术后累积生存率显著低于血糖水平≤8.3 mmol/L的患者，平均生存时间显著更短（P<0.05）。
术中血糖水平与CPB手术后并发AKI的先天性心脏病患儿的预后相关。维持术中良好的血糖控制可改善患儿预后。
