Ostermann Marlies, Kunst Gudrun, Baker Eleanor, Weerapolchai Kittisak, Lumlertgul Nuttha
Department of Critical Care, King's College London, Guy's & St Thomas' NHS Foundation Trust, London SE1 7EH, UK.
Department of Anaesthesia, School of Cardiovascular Medicine & Sciences, King's College Hospital, King's College London, London SE5 9RS, UK.
J Clin Med. 2021 Nov 14;10(22):5285. doi: 10.3390/jcm10225285.
Acute kidney injury (AKI) is common after cardiac surgery. To date, there are no specific pharmacological therapies. In this review, we summarise the existing evidence for prevention and management of cardiac surgery-associated AKI and outline areas for future research. Preoperatively, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers should be withheld and nephrotoxins should be avoided to reduce the risk. Intraoperative strategies include goal-directed therapy with individualised blood pressure management and administration of balanced fluids, the use of circuits with biocompatible coatings, application of minimally invasive extracorporeal circulation, and lung protective ventilation. Postoperative management should be in accordance with current KDIGO AKI recommendations.
急性肾损伤（AKI）在心脏手术后很常见。迄今为止，尚无特异性药物治疗方法。在本综述中，我们总结了预防和管理心脏手术相关AKI的现有证据，并概述了未来研究的领域。术前，应停用血管紧张素转换酶抑制剂和血管紧张素受体阻滞剂，并避免使用肾毒素以降低风险。术中策略包括目标导向治疗，采用个体化血压管理和输注平衡液，使用具有生物相容性涂层的回路，应用微创体外循环，以及肺保护性通气。术后管理应符合当前KDIGO急性肾损伤指南的建议。
