Lim Ju Yong, Kang Pil Je, Jung Sung Ho, Choo Suk Jung, Chung Cheol Hyun, Lee Jae Won, Kim Joon Bum
Departments of Thoracic and Cardiovascular Surgery, Anam Hospital, University of Korea College of Medicine, Seoul, Republic of Korea.
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
J Thorac Dis. 2018 Dec;10(12):6753-6762. doi: 10.21037/jtd.2018.10.113.
Fluid resuscitation is critical to perioperative maintenance of adequate preload and cardiac output after cardiac surgery. Liberal use of saline, however, is reportedly associated with an increased risk of acute kidney injury (AKI) in critically ill patients. This study examined the effects of high- versus low-volume saline administration on AKI after cardiac surgery.
In this retrospective study, we evaluated 1,740 consecutive patients who underwent cardiac surgery over a 2-year period. The patients were divided into high-volume saline (n=328, 18.8%) and low-volume saline (n=1,412, 81.2%) groups based on the amount of saline (>1 or ≤1 L, respectively) administered during the first 48 postoperative hours.
AKI, the primary outcome, was defined according to the Risk, Injury, Failure, Loss, End Stage classification. There were no significant differences in the incidence of AKI (P=0.46), new renal replacement therapy (RRT) (P=0.39), and early mortality (P=0.52) between the 2 groups. Adjustment of baseline characteristics using propensity score matching showed that high-volume of saline administration was not significantly associated with an increased risk of AKI (OR, 1.22; 95% CI, 0.77-1.93; P=0.38), new RRT (OR, 1.25; 95% CI, 0.68-2.28; P=0.45), or early mortality (HR, 0.98; 95% CI, 0.48-2.02; P=0.97). These results were validated by further adjustments for significant covariates.
High-volume administration of saline in the period following cardiac surgery was not associated with a significant increase in the risk of AKI.
液体复苏对于心脏手术后围手术期维持足够的前负荷和心输出量至关重要。然而，据报道，在危重症患者中大量使用生理盐水与急性肾损伤（AKI）风险增加有关。本研究探讨了高容量与低容量生理盐水输注对心脏手术后AKI的影响。
在这项回顾性研究中，我们评估了连续2年接受心脏手术的1740例患者。根据术后48小时内输注的生理盐水用量（分别>1L或≤1L），将患者分为高容量生理盐水组（n=328，18.8%）和低容量生理盐水组（n=1412，81.2%）。
主要结局AKI根据风险、损伤、衰竭、丧失、终末期分类进行定义。两组之间AKI的发生率（P=0.46）、新的肾脏替代治疗（RRT）（P=0.39）和早期死亡率（P=0.52）无显著差异。使用倾向评分匹配对基线特征进行调整后显示，高容量生理盐水输注与AKI风险增加（OR，1.22；95%CI，0.77-1.93；P=0.38）、新的RRT（OR，1.25；95%CI，0.68-2.28；P=0.45）或早期死亡率（HR，0.98；95%CI，0.48-2.02；P=0.97）无显著相关性。通过对显著协变量进行进一步调整，验证了这些结果。
心脏手术后高容量输注生理盐水与AKI风险显著增加无关。
