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高中心静脉压与体外循环手术后患者的急性肾损伤和死亡率有关。

High central venous pressure is associated with acute kidney injury and mortality in patients underwent cardiopulmonary bypass surgery.

机构信息

Center of Anesethology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Rd, ChaoYang District, Beijing 100029, China.

Center of Anesethology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Rd, ChaoYang District, Beijing 100029, China.

出版信息

J Crit Care. 2018 Dec;48:211-215. doi: 10.1016/j.jcrc.2018.08.034. Epub 2018 Sep 4.

Abstract

PURPOSE

We sought to investigate the relationship between high CVP, AKI, and mortality in patients undergoing cardiac surgery with cardiopulmonary bypass.

MATERIALS

All patients aged 18 years or older who underwent cardiac surgery with CPB were prospectively reviewed. Patients were excluded when renal artery were involved before and during surgery. Patients were dichotomized into high CVP group(>10 mmHg) and low CVP group(<10 mmHg). All patients were followed by telephone.

RESULTS

A total of 1941 patients were included in observed study. In high CVP group, three hundred forty-seven patients (43.32%) developed AKI, while eighty-six (7.543%) in low CVP group(P <0.0001). Furthermore, in every KDIGO stage, patients of AKI in high CVP group were more than those in low CVP group(P <0.0001). The incidence of AKI increased as CVP increased, especially when CVP was higher than 10cmH2O. In a median follow-up time of 9.2 months, Crude mortality is 8.365% in the high CVP group compared to 1.929% in the low CVP group (p<0.0001). In multivariate analysis, CVP remained the independent predictor of survival.

CONCLUSIONS

High CVP is associated with AKI , and it is independently related to all-cause mortality in patients underwent cardiovascular surgery with cardiopulmonary bypass.

摘要

目的

我们旨在探讨体外循环心脏手术患者中心静脉压(CVP)升高、急性肾损伤(AKI)和死亡率之间的关系。

材料

所有年龄在 18 岁或以上并接受 CPB 心脏手术的患者均进行前瞻性回顾。排除手术前和手术期间肾动脉受影响的患者。将患者分为 CVP 高组(>10mmHg)和 CVP 低组(<10mmHg)。所有患者均通过电话进行随访。

结果

共纳入 1941 例患者进行观察研究。在 CVP 高组中,347 例(43.32%)患者发生 AKI,而 CVP 低组中 86 例(7.543%)(P<0.0001)。此外,在每个 KDIGO 分期中,CVP 高组的 AKI 患者均多于 CVP 低组(P<0.0001)。随着 CVP 的增加,AKI 的发生率增加,尤其是当 CVP 高于 10cmH2O 时。在中位随访时间为 9.2 个月时,CVP 高组的粗死亡率为 8.365%,而 CVP 低组为 1.929%(p<0.0001)。多变量分析显示,CVP 仍然是生存的独立预测因素。

结论

CVP 升高与 AKI 相关,与体外循环心脏手术后患者的全因死亡率独立相关。

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