Intensive Cardiac Therapy Clinic, Department of Invasive Cardiology and Electrocardiology, Medical University of Lodz, Poland.
Cardiosurgery Clinic, Department of Cardiology and Cardiosurgery, Medical University of Lodz, Poland.
Adv Clin Exp Med. 2020 Feb;29(2):189-196. doi: 10.17219/acem/112610.
Cardiac surgery-associated acute kidney injury (CSA-AKI) is a well-known, serious complication and a well-recognized independent risk factor for higher morbidity and mortality among patients undergoing cardiac surgery.
The aim of the study was to assess the efficacy of remote ischemic preconditioning (RIPC) in reducing the incidence of CSA-AKI, measured with the standard creatinine technique and using neutrophil gelatinase-associated lipocalin (NGAL) serum concentrations as a potential new biomarker of kidney damage. The ethics committee of the Medical University of Lodz prospectively approved the protocol (approval No. RNN/286/13/KE). The study was retrospectively registered with the U.S. National Institutes of Health - NIH (29 June 2017; ClinicalTrials.gov identifier: NCT03205410).
We conducted a prospective single-center double-blind randomized and controlled tudy. Data was collected from patients admitted to the Cardiosurgery Clinic at the Medical University of Lodz (Poland) between January and December 2014, scheduled for elective cardiac surgery (an off-pump coronary artery bypass). A total of 28 patients were randomized to receive either RIPC (n = 14) or sham RIPC (n = 14). After the induction of anesthesia, the patients assigned to the RIPC group underwent 3 cycles of five-minute inflation to 200 mm Hg and five-minute deflation of the upper-arm cuff. The control group had a deflated cuff placed on the upper arm for 30 min. The authors measured the patients' serum creatinine concentration to check for the occurrence of a CSA-AKI within 48 h after cardiac surgery, and NGAL serum concentration to check its level within 3 h after the operation.
Fewer patients in RIPC group developed CSA-AKI within 48 h after cardiac surgery than in the control group (29% vs 93%; p = 0.003). Fewer patients in the RIPC group presented an increase in NGAL 3 h after surgery (medians: 124 vs 176.7; p = 0.0003).
In patients undergoing an off-pump coronary artery bypass, RIPC significantly reduces the occurrence of CSA-AKI and protects against increased postoperative NGAL levels.
心脏手术相关急性肾损伤（CSA-AKI）是一种众所周知的严重并发症，也是心脏手术后患者发病率和死亡率升高的公认独立危险因素。
本研究旨在评估远程缺血预处理（RIPC）在降低 CSA-AKI 发生率方面的疗效，使用标准肌酐技术测量，并使用中性粒细胞明胶酶相关脂质运载蛋白（NGAL）血清浓度作为肾脏损伤的潜在新生物标志物。罗兹医科大学伦理委员会前瞻性批准了该方案（批准号 RNN/286/13/KE）。该研究随后在美国国立卫生研究院（NIH）进行了回顾性注册（2017 年 6 月 29 日；临床试验.gov 标识符：NCT03205410）。
我们进行了一项前瞻性、单中心、双盲、随机对照研究。数据收集于 2014 年 1 月至 12 月期间在罗兹医科大学心脏外科诊所（波兰）接受择期心脏手术（非体外循环冠状动脉旁路移植术）的患者。共有 28 名患者被随机分为 RIPC 组（n = 14）或假 RIPC 组（n = 14）。麻醉诱导后，RIPC 组患者接受 3 个 5 分钟的循环，将上臂袖带充气至 200mmHg，然后放气 5 分钟。对照组的上臂袖带放气 30 分钟。作者测量了患者的血清肌酐浓度，以检查心脏手术后 48 小时内是否发生 CSA-AKI，并测量了手术 3 小时后的血清 NGAL 浓度。
与对照组相比，RIPC 组患者在心脏手术后 48 小时内发生 CSA-AKI 的人数更少（29% vs 93%；p = 0.003）。RIPC 组患者术后 3 小时 NGAL 升高的人数更少（中位数：124 与 176.7；p = 0.0003）。
在接受非体外循环冠状动脉旁路移植术的患者中，RIPC 可显著降低 CSA-AKI 的发生，并防止术后 NGAL 水平升高。
