Department of Anesthesiology, Division of Cardiothoracic Anesthesiology, Cooper University Hospital, Camden, NJ, United States; Cooper Medical School of Rowan University, Camden, NJ, United States.
Cooper Medical School of Rowan University, Camden, NJ, United States.
J Cardiothorac Vasc Anesth. 2022 Nov;36(11):4070-4076. doi: 10.1053/j.jvca.2022.06.040. Epub 2022 Jul 6.
To investigate if oxygen delivery index during cardiopulmonary bypass (DOI) was more strongly associated with acute kidney injury (AKI), the higher the patient's preoperative pulse pressure (PP).
Retrospective cohort of 1064 patients undergoing cardiac surgery.
Single academic healthcare center.
Adult patients undergoing coronary artery bypass grafting, valve, aortic, or combined surgery requiring cardiopulmonary bypass.
Hemoglobin, arterial oxygen saturation, and pump flow recorded no fewer than every 30 min were extracted from the patients' perfusion records, and DOI was calculated. The AKI was assessed from the pre- and postoperative creatinine and urine output values using the Acute Kidney Injury Network criteria. The sample was stratified in 5 categories of progressively higher PP. The patient characteristics and intraoperative variables were evaluated in univariate analysis for a relationship with AKI. The significant risk factors from the univariate analysis then were evaluated in a multivariate analysis and assessed for logistic fit with respect to AKI.
The AKI assessed as a binary outcome.
Age, body surface area, DOI, history of heart failure, and baseline creatinine were associated significantly with AKI, as was an interaction term between the PP category and DOI (p = 0.0067). The higher the PP category, the stronger the observed association between DOI and AKI, and the higher the variability in the predicted risk of AKI dependent on DOI.
A lower DOI during cardiopulmonary bypass appeared more strongly associated with a higher likelihood of developing AKI, the higher the patient's preoperative pulse pressure.
探讨体外循环期间氧输送指数（DOI）与急性肾损伤（AKI）的相关性，是否术前脉压（PP）越高，相关性越强。
回顾性分析了 1064 例行心脏手术的患者。
单家学术医疗机构。
接受冠状动脉旁路移植术、瓣膜、主动脉或需要体外循环的联合手术的成年患者。
从患者的灌注记录中提取至少每 30 分钟记录的血红蛋白、动脉血氧饱和度和泵流量，并计算 DOI。根据急性肾损伤网络标准，使用术前和术后肌酐和尿量评估 AKI。将患者分为 5 组，每组的 PP 逐渐升高。在单变量分析中评估患者特征和术中变量与 AKI 的关系。然后对单变量分析中的显著危险因素进行多变量分析，并评估其与 AKI 的逻辑拟合度。
AKI 评估为二项结果。
年龄、体表面积、DOI、心力衰竭史和基线肌酐与 AKI 显著相关，PP 类别和 DOI 之间的交互项也与 AKI 显著相关（p=0.0067）。PP 类别越高，DOI 与 AKI 之间的观察相关性越强，DOI 依赖性 AKI 的预测风险变化越大。
体外循环期间 DOI 越低，发生 AKI 的可能性越大，患者术前的 PP 越高。
