Ramkumar Jayavelan, Gopinathan Girish, Kavin Karthick, Shanmugasundaram Ramkumar, Stephen George Miller, Pragasam Annie Caroline, Thangavel Periyasamy
Department of Cardiothoracic Surgery, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai 600116, India.
J Saudi Heart Assoc. 2020 Apr 17;32(1):40-45. doi: 10.37616/2212-5043.1007. eCollection 2020.
The primary objective of this investigation was to study the effects of cardiopulmonary bypass (CPB) perfusion temperature on renal function parameters [serum creatinine, creatinine clearance, urine albumin, urine protein, and urine albumin/creatinine ratio (ACR)]. The secondary objective was to detect renal complications of CPB.
This is a prospective longitudinal study of 30 adult patients (17 men, 13 women; mean age, 53.37 ± 16.02 years) who underwent valvular heart surgery [with or without coronary artery bypass grafting (CABG)]. Serum creatinine, creatinine clearance, urine protein, urine albumin, and urine ACR were collected during CPB (at 28 °C, 32 °C, and 37 °C) and postoperatively (at 12 hours, 24 hours, and 48 hours). Data were analyzed using one-way repeated-measures analysis of variance (ANOVA). A significant ANOVA was followed by a Bonferroni-Holm test.
Although serum creatinine ( < 0.001) and creatinine clearance ( = 0.0016) underwent a significant ANOVA change ( < 0.001 and = 0.0016, respectively) after CPB, there was no statistically significant change compared with their baseline values. Urine ACR showed a significant change at 28 °C ( < 0.01), 32 °C ( < 0.01), and 37 °C ( < 0.05) as compared with baseline values. No significant change in urine albumin was observed during CPB or up to 24 hours. A significant change occurred after 48 hours of CPB ( < 0.05). A significant increase in urine protein was noted after CPB at 12 hours ( < 0.01), 24 hours ( < 0.01), and 48 hours ( < 0.01). Overall, 12 (40%) patients had acute kidney injury (AKI). Ten (33.33%) patients had stage I AKI, one patient progressed to AKI stage II, and another to AKI stage III. Of the 10 patients who had stage I AKI, eight had complete recovery within 48 hours.
CPB with moderate hypothermia for valvular heart surgeries can be performed safely in patients with adequate renal functional reserve. The glomerular permeability across the Bowman's capsule increases after CPB as evidenced by significant proteinuria at 12 hours and increased albuminuria at 48 hours after surgery. There is an increased risk of transient stage I AKI after CPB, from which patients recover within 48 hours.
本研究的主要目的是探讨体外循环（CPB）灌注温度对肾功能参数[血清肌酐、肌酐清除率、尿白蛋白、尿蛋白及尿白蛋白/肌酐比值（ACR）]的影响。次要目的是检测CPB的肾脏并发症。
这是一项对30例成年患者（17例男性，13例女性；平均年龄53.37±16.02岁）进行的前瞻性纵向研究，这些患者接受了心脏瓣膜手术[伴或不伴冠状动脉旁路移植术（CABG）]。在CPB期间（28℃、32℃和37℃）及术后（12小时、24小时和48小时）收集血清肌酐、肌酐清除率、尿蛋白、尿白蛋白及尿ACR。采用单因素重复测量方差分析（ANOVA）对数据进行分析。方差分析有显著差异后，进行Bonferroni-Holm检验。
尽管CPB后血清肌酐（<0.001）和肌酐清除率（=0.0016）有显著的方差分析变化（分别为<0.001和=0.0016），但与基线值相比无统计学显著变化。与基线值相比，尿ACR在28℃（<0.01）、32℃（<0.01）和37℃（<0.05）时显示出显著变化。CPB期间及术后24小时内尿白蛋白无显著变化。CPB 48小时后发生显著变化（<0.05）。CPB后12小时（<0.01）、24小时（<0.01）和48小时（<0.01）尿蛋白显著增加。总体而言，12例（40%）患者发生急性肾损伤（AKI）。10例（33.33%）患者为Ⅰ期AKI，1例进展为Ⅱ期AKI，另1例进展为Ⅲ期AKI。在10例Ⅰ期AKI患者中，8例在48小时内完全恢复。
对于具有足够肾功能储备的患者，心脏瓣膜手术采用中度低温CPB可安全进行。CPB后肾小球滤过屏障通透性增加，表现为术后12小时蛋白尿显著增加及48小时白蛋白尿增加。CPB后发生短暂Ⅰ期AKI的风险增加，但患者在48小时内恢复。
