经食管超声心动图评估肾血管阻力指数在冠状动脉旁路移植术患者急性肾损伤评估中的应用：一项前瞻性观察研究。
Intraoperative evaluation of renal resistive index with transesophageal echocardiography for the assessment of acute renal injury in patients undergoing coronary artery bypass grafting surgery: A prospective observational study.
机构信息
Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Department of Fellow Pediatric Cardiac Anaesthesia, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
出版信息
Ann Card Anaesth. 2022 Apr-Jun;25(2):158-163. doi: 10.4103/aca.aca_221_20.
BACKGROUND
Acute kidney injury (AKI) is a common complication after on pump coronary artery bypass grafting (CABG) surgery and is associated with a poor prognosis. Postoperative AKI is associated with morbidity, mortality, and increase in length of intensive care unit (ICU) stay and increases the financial burden. Identifying individuals at risk for developing AKI in postoperative period is extremely important to optimize outcomes. The aim of the study is to evaluate the association between the intraoperative transesophageal echocardiography (TEE) derived renal resistive index (RRI) and AKI in patients undergoing on-pump CABG surgery.
METHODS
This prospective observational study was conducted in patients more than 18 years of age undergoing elective on pump CABG surgery between July 1, 2018, and December 31, 2019, at a tertiary care center. All preoperative, intraoperative, and postoperative parameters were recorded. TEE measurement was performed in hemodynamically stable patients before the sternum was opened. Postoperative AKI was diagnosed based on the serial measurement of serum creatinine and the monitoring of urine output.
RESULTS
A total of 115 patients were included in our study. Thirty-nine (33.91%) patients had RRI >0.7 while remaining seventy-six (66.08%) patients had RRI <0.7. AKI was diagnosed in 26% (30/115) patients. AKI rates were significantly higher in patients with RRI values exceeding 0.7 with 46.15% (18/39) compared to 15.75% (12/76) in RRI values of less than 0.7. Multivariate analysis revealed that AKI was associated with an increase in RRI and diabetes mellitus. The RRI assessed by receiver operating characteristic (ROC) curve and the area under the curve (AUC) to distinguish between non-AKI and AKI groups were 0.705 (95% CI: 0.588-0.826) for preoperative RRI. The most accurate cut-off value to distinguish non-AKI and AKI groups was a preoperative RRI of 0.68 with a sensitivity of 70% and specificity of 67%.
CONCLUSIONS
An increased intraoperative RRI is an independent predictor of AKI in the postoperative period in patients undergoing CABG surgery. The cutoff value of TEE-derived RRI in the intraoperative period should be >0.68 to predict AKI in the postoperative period.
背景
急性肾损伤（AKI）是体外循环冠状动脉旁路移植术（CABG）后常见的并发症，与预后不良相关。术后 AKI 与发病率、死亡率以及重症监护病房（ICU）住院时间延长和经济负担增加有关。识别术后发生 AKI 的高危人群对于优化结局非常重要。本研究旨在评估术中经食管超声心动图（TEE）获得的肾阻力指数（RRI）与行体外循环 CABG 手术患者 AKI 之间的相关性。
方法
这是一项前瞻性观察性研究，纳入 2018 年 7 月 1 日至 2019 年 12 月 31 日期间在三级护理中心行择期体外循环 CABG 手术的年龄超过 18 岁的患者。记录所有术前、术中及术后参数。在胸骨未打开时，对血流动力学稳定的患者进行 TEE 测量。根据血清肌酐的连续测量和尿量监测诊断术后 AKI。
结果
本研究共纳入 115 例患者。39 例（33.91%）患者的 RRI>0.7，而其余 76 例（66.08%）患者的 RRI<0.7。30 例（26.09%）患者发生 AKI。RRI 值超过 0.7 的患者 AKI 发生率明显高于 RRI 值小于 0.7 的患者（46.15%[18/39]与 15.75%[12/76]）。多变量分析显示，AKI 与 RRI 增加和糖尿病有关。术前 RRI 评估的受试者工作特征（ROC）曲线和曲线下面积（AUC）以区分非 AKI 和 AKI 组分别为 0.705（95%CI：0.588-0.826）。术前 RRI 区分非 AKI 和 AKI 组的最佳截断值为 0.68，敏感性为 70%，特异性为 67%。
结论
体外循环 CABG 术后，术中 RRI 增加是 AKI 的独立预测因素。术中 TEE 衍生 RRI 的截断值应>0.68，以预测术后 AKI。
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