Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia.
Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia.
J Thorac Cardiovasc Surg. 2022 Apr;163(4):1393-1403.e9. doi: 10.1016/j.jtcvs.2020.03.182. Epub 2020 Jun 25.
Acute kidney injury (AKI) is a serious complication of cardiac surgery with cardiopulmonary bypass (CPB). The aim of this study was to evaluate the effects of nitric oxide (NO) supplementation to the CPB circuit on the development of cardiac surgery-associated AKI.
This prospective randomized controlled study included 96 patients with moderate risk of renal complications who underwent elective cardiac surgery with CPB. The study protocol was registered at ClinicalTrials.gov (identifier NCT03527381). Patients were randomly allocated to either NO supplementation to the CPB bypass circuit (NO treatment group; n = 48) or usual care (control group; n = 48). In the NO treatment group, 40-ppm NO was administered during the entire CPB period. The primary outcome was the incidence of AKI.
NO treatment was associated with a significant decrease in AKI incidence (10 cases [20.8%] vs 20 cases [41.6%] in the control group; relative risk, 0.5; 95% confidence interval, 0.26-0.95; P = .023) and a higher median urine output during CPB (2.6 mL/kg/h [interquartile range (IQR), 2.1-5.08 mL/kg/h] vs 1.7 mL/kg/h [IQR, 0.80-2.50 mL/kg/h]; P = .0002). The median urinary neutrophil gelatinase-associated lipocalin level at 4 hours after surgery was significantly lower in the NO treatment group (1.12 ng/mL [IQR, 0.75-5.8 ng/mL] vs 4.62 ng/mL [IQR, 2.02-34.55 ng/mL]; P = .005). In the NO treatment group, concentrations of NO metabolites were significantly increased at 5 minutes postclamping, at 5 minutes after declamping, and at the end of the operation. Concentrations of proinflammatory and anti-inflammatory mediators and free plasma hemoglobin did not differ significantly between the 2 groups.
NO administration in patients at moderate risk of renal complications undergoing elective cardiac surgery with CPB was associated with a lower incidence of AKI.
急性肾损伤（AKI）是体外循环（CPB）心脏手术后的一种严重并发症。本研究旨在评估 CPB 回路中补充一氧化氮（NO）对心脏手术相关 AKI 发展的影响。
本前瞻性随机对照研究纳入 96 例有中度肾脏并发症风险的择期 CPB 心脏手术患者。研究方案在 ClinicalTrials.gov 注册（标识符 NCT03527381）。患者随机分配至 CPB 旁路回路中补充 NO（NO 治疗组；n=48）或常规治疗（对照组；n=48）。在 NO 治疗组中，40ppm 的 NO 在整个 CPB 期间持续给药。主要结局是 AKI 的发生率。
NO 治疗组 AKI 发生率显著降低（10 例[20.8%]与对照组 20 例[41.6%]；相对风险，0.5；95%置信区间，0.26-0.95；P=0.023），CPB 期间的平均尿量更高（2.6mL/kg/h[四分位距（IQR），2.1-5.08mL/kg/h]与 1.7mL/kg/h[IQR，0.80-2.50mL/kg/h]；P=0.0002）。术后 4 小时，NO 治疗组尿液中性粒细胞明胶酶相关脂质运载蛋白水平显著较低（1.12ng/mL[IQR，0.75-5.8ng/mL]与 4.62ng/mL[IQR，2.02-34.55ng/mL]；P=0.005）。NO 治疗组在阻断后 5 分钟、阻断后 5 分钟和手术结束时的 NO 代谢物浓度显著升高。两组间促炎和抗炎介质以及游离血浆血红蛋白的浓度无显著差异。
在有中度肾脏并发症风险的择期 CPB 心脏手术患者中，CPB 回路中补充 NO 与 AKI 发生率降低相关。
