Department of Cardiothoracic Anaesthesiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
Department of Cardiothoracic Surgery, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
Acta Anaesthesiol Scand. 2019 Nov;63(10):1290-1297. doi: 10.1111/aas.13457. Epub 2019 Sep 10.
Acute kidney injury is a serious complication following cardiac surgery associated with mortality. Restricted oxygen delivery is a potential risk factor for acute kidney injury. The aim of this study was to investigate the impact of the duration of low oxygen delivery (<272 mL min m ), during cardiopulmonary bypass on kidney function.
Patients undergoing coronary artery bypass graft surgery ± valve repair were included n = 1968. Oxygen delivery was monitored during cardiopulmonary bypass. Data were explored using multiple regression analyses regarding association between low oxygen delivery and renal replacement therapy (RRT), acute kidney injury (AKI) and post-operative peak serum creatinine (PPSC).
Post-operative peak serum creatinine, incidence of acute kidney injury, and need for dialysis increased in a dose-dependent manner in relation to duration of a mean oxygen delivery <272 mL min m . Using multiple regression analyses, only exposure for at least 30 minutes was independently associated with increased PPSC and AKI. In contrast, both short (1-5 min, OR: 2.58 [1.20, 5.54]; P = .015) and at least 30-minute (OR: 2.85 [1.27-6.41]; P = .011) exposure to low DO were both independently associated with the need for RRT.
A low oxygen delivery during cardiopulmonary bypass was in a dose-dependent manner associated with an increased risk of renal injury.
急性肾损伤是心脏手术后的一种严重并发症，与死亡率相关。氧供受限是急性肾损伤的潜在危险因素。本研究旨在探讨体外循环期间低氧供（<272ml/min/m2）持续时间对肾功能的影响。
纳入 1968 例行冠状动脉旁路移植术+瓣膜修复术的患者。体外循环期间监测氧供。使用多元回归分析探讨低氧供与肾脏替代治疗（RRT）、急性肾损伤（AKI）和术后血清肌酐峰值（PPSC）之间的关系。
术后血清肌酐峰值、急性肾损伤发生率和透析需求与平均氧供<272ml/min/m2的持续时间呈剂量依赖性增加。使用多元回归分析，只有至少 30 分钟的暴露与 PPSC 和 AKI 的增加独立相关。相比之下，短时间（1-5 分钟，OR：2.58 [1.20, 5.54]；P=0.015）和至少 30 分钟（OR：2.85 [1.27-6.41]；P=0.011）的低 DO 暴露均与 RRT 的需求独立相关。
体外循环期间低氧供与肾损伤风险增加呈剂量依赖性相关。
