Department of Cardiac Surgery, University Medical Centre Maribor, Maribor, Slovenia.
Department of Cardiovascular Surgery, Institute of Cardiovascular Diseases of Vojvodina, Sremska Kamenica, Vojvodina, Serbia.
Thorac Cardiovasc Surg. 2022 Oct;70(7):566-574. doi: 10.1055/s-0042-1744262. Epub 2022 May 28.
Acute kidney injury (AKI) is associated with higher perioperative mortality and morbidity. Oxidative stress has been proposed as a cause of postoperative AKI. Ascorbic acid (AA) supplementation was suggested as a novel and promising antioxidant. The aim of this study was to evaluate the capability of AA to reduce the incidence of postoperative AKI in cardiac surgery patients.
A prospective randomized trial was conducted in patients scheduled for on-pump cardiac surgery. Subjects in the AA group received 2 g of AA intravenously during the induction of anesthesia, 2 g before aortic cross-clamp removal and 1 g every 8 hours for five postoperative days (the JERICA protocol). Postoperatively, the patients were monitored for AKI and other complications. Malondialdehyde levels were monitored in a subpopulation of 100 patients to evaluate the effect of AA on oxidative stress level.
The AA and control group consisted of 163 and 169 patients, respectively. The groups were well matched for baseline demographics and had similar intraoperative characteristics. The incidence of AKI in the AA and control group was 20.9 and 28.4%, respectively ( = 0.127). The estimated glomerular filtration rate did not differ between the study groups in the entire postoperative period. There was a trend toward higher malondialdehyde values with statistical significance on postoperative day 1 and lower in-hospital mortality in the AA group (0.6 vs. 4.1%, = 0.067).
Our results do not support the effectiveness of AA supplementation in reducing the incidence of postoperative AKI in on-pump cardiac surgery patients.
This study was registered with the ISRCTN Registry under the trial registration number ISRCTN98572043.
急性肾损伤（AKI）与更高的围手术期死亡率和发病率相关。氧化应激被认为是术后 AKI 的一个原因。抗坏血酸（AA）的补充被认为是一种新型且有前途的抗氧化剂。本研究旨在评估 AA 降低体外循环心脏手术患者术后 AKI 发生率的能力。
对拟行体外循环心脏手术的患者进行前瞻性随机试验。AA 组患者在麻醉诱导时静脉注射 2 g AA，在主动脉阻断夹移除前给予 2 g，术后 5 天每 8 小时给予 1 g（JERICA 方案）。术后监测 AKI 和其他并发症。在 100 例患者的亚群中监测丙二醛水平，以评估 AA 对氧化应激水平的影响。
AA 组和对照组分别有 163 例和 169 例患者。两组患者的基线人口统计学特征和术中特征均匹配良好。AA 组和对照组 AKI 的发生率分别为 20.9%和 28.4%（ = 0.127）。在整个术后期间，研究组之间的估计肾小球滤过率没有差异。AA 组术后第 1 天丙二醛值较高，有统计学意义，住院死亡率较低（0.6%比 4.1%， = 0.067）。
我们的结果不支持 AA 补充在降低体外循环心脏手术患者术后 AKI 发生率方面的有效性。
本研究在 ISRCTN 注册处注册，试验注册号为 ISRCTN98572043。
