Division of Pediatric Cardiology, University of Michigan C.S. Mott Children's Hospital, 1540 E Hospital Drive, Ann Arbor, MI, 48109, USA.
Division of Cardiac Critical Care, The Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA.
Pediatr Nephrol. 2021 Sep;36(9):2875-2881. doi: 10.1007/s00467-021-04976-2. Epub 2021 Mar 2.
Ultrafiltration (UF) is used for fluid removal during and after infant cardiopulmonary bypass (CPB) surgery to reduce fluid overload. Excessive UF may have the opposite of its intended effect, resulting in acute kidney injury (AKI), oliganuria, and fluid retention.
This is a single-center, retrospective review of infants treated with conventional and/or modified UF during CPB surgery. UF volume was indexed to weight. AKI was defined using serum creatinine "Kidney Disease Improving Global Outcome (KDIGO)" criteria. Fluid balance was defined according to: [Formula: see text]. Peak fluid overload was determined on postoperative day 3. Multivariable logistic regression adjusted for multiple covariates was used to explore associations with UF, AKI, and fluid overload.
Five hundred thirty subjects < 1 year of age underwent CPB-assisted congenital heart surgery with UF. Sixty-four (12%) developed postoperative AKI. On multivariable regression, higher indexed total UF volume was associated with increased AKI risk (OR 1.11, 95% CI=1.04-1.19, p = 0.003). UF volume > 119.9 mL/kg did not reduce peak fluid overload. Subjects with AKI took longer to reach a negative fluid balance (2 vs. 3 days, p = 0.04). Those with more complex surgery were at highest AKI risk (STAT 3 [25-75 percentile: 3-4] in AKI group versus STAT 3 [25-75 percentile: 2-4] in non-AKI group, p = 0.05). AKI was reduced in subjects undergoing more complex surgery and treated with UF volume < 119.9 mL/kg.
Judicious use of UF in more complex congenital cardiac surgery reduces the risk of AKI.
超滤（UF）用于婴儿体外循环（CPB）手术期间和之后的液体清除，以减少液体超负荷。超滤过多可能会产生相反的效果，导致急性肾损伤（AKI）、少尿和液体潴留。
这是一项对接受 CPB 手术中常规和/或改良 UF 治疗的婴儿进行的单中心回顾性研究。超滤量与体重相关。AKI 定义为血清肌酐“肾脏病改善全球结局（KDIGO）”标准。液体平衡根据[公式：见正文]定义。术后第 3 天确定最大液体超负荷。采用多变量逻辑回归分析调整多个协变量，探讨 UF、AKI 和液体超负荷之间的关系。
530 名<1 岁婴儿接受 CPB 辅助先天性心脏病手术并进行 UF。64 例（12%）发生术后 AKI。多变量回归显示，总 UF 量指数越高，AKI 风险增加（OR 1.11，95%CI=1.04-1.19，p=0.003）。UF 量>119.9mL/kg 并不能降低最大液体超负荷。发生 AKI 的患者达到负液体平衡的时间更长（2 天与 3 天，p=0.04）。手术更复杂的患者 AKI 风险最高（AKI 组 STAT 3[25-75 百分位数：3-4]与非 AKI 组 STAT 3[25-75 百分位数：2-4]，p=0.05）。在手术更复杂的患者中，UF 量<119.9mL/kg 时，AKI 减少。
在更复杂的先天性心脏手术中合理使用 UF 可降低 AKI 风险。
