Kanchi Muralidhar, Manjunath Rudresh, Maessen Jos, Vincent Lloyd, Belani Kumar
Department of Anesthesia and Intensive Care, Narayana Institute of Cardiac Sciences, Narayana Health, Bengaluru, Karnataka, India.
Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
J Anaesthesiol Clin Pharmacol. 2018 Jul-Sep;34(3):301-306. doi: 10.4103/joacp.JOACP_75_18.
Acute kidney injury (AKI) following cardiac surgery is a major complication resulting in increased morbidity, mortality and economic burden. This study was designed to determine the benefit of sodium bicarbonate (NaHCO) supplementation in patients with stable chronic kidney disease (CKD) undergoing off-pump coronary artery bypass grafting (OP-CABG).
We prospectively studied 60 non-dialysis CKD patients with glomerular filtration rate (GFR) ≤60 ml/min/1.73 m requiring elective OP-CABG. They were randomly allocatted to one of the two groups. One group received NaHCO infusion at 0.5 mmol/kg first hour followed by 0.2 mmol/kg/h till the end of surgery and the other group received 0.9% NaCl. A third group of 30 patients without renal dysfunction undergoing OP-CABG was included. The serum creatinine was estimated prior to surgery, immediately after surgery and on postoperative days 1, 2, 3 and 4.
Ten patients (33.3%) in NaCl and 6 (20%) patients each in NaHCO and normal groups developed Stage-1 AKI. None of our study patient required renal replacement therapy and no mortality was observed in any of the groups during the perioperative and hospitalization period.
Perioperative infusion of NaHCO in OP-CABG reduced the incidence of Stage-1 AKI by about 40% when compared to NaCl. The incidence of Stage-I AKI in NaHCO group was similar to that in patients with normal renal function undergoing OP-CABG. A larger group of patients may be required to suggest a significance of renal protective benefit of NaHCO in patients undergoing OP-CABG.
心脏手术后的急性肾损伤（AKI）是一种主要并发症，会导致发病率、死亡率和经济负担增加。本研究旨在确定补充碳酸氢钠（NaHCO）对接受非体外循环冠状动脉搭桥术（OP-CABG）的稳定慢性肾脏病（CKD）患者的益处。
我们前瞻性地研究了60例肾小球滤过率（GFR）≤60 ml/min/1.73 m²且需要择期OP-CABG的非透析CKD患者。他们被随机分配到两组中的一组。一组在手术开始的第1小时接受0.5 mmol/kg的NaHCO输注，随后以0.2 mmol/kg/h的速度持续输注直至手术结束，另一组接受0.9%氯化钠溶液。纳入了第三组30例接受OP-CABG且无肾功能障碍的患者。在手术前、手术后即刻以及术后第1、2、3和4天测定血清肌酐。
接受氯化钠溶液组有10例患者（33.3%）发生1期AKI，接受NaHCO组和正常肾功能组各有6例患者（20%）发生1期AKI。我们的研究患者均无需肾脏替代治疗，在围手术期和住院期间，任何一组均未观察到死亡病例。
与氯化钠溶液相比，OP-CABG围手术期输注NaHCO可使1期AKI的发生率降低约40%。NaHCO组1期AKI的发生率与接受OP-CABG的肾功能正常患者相似。可能需要更大规模的患者群体来表明NaHCO对接受OP-CABG患者肾脏保护益处的显著性。
