Department of Congenital Heart Surgery and Pediatric Heart Surgery, German Heart Center Berlin, Berlin, Germany.
Department of Cardiac Anesthesiology and Intensive Care Medicine, German Heart Center Berlin, Berlin, Germany; Department of Cardiac Anesthesiology and Intensive Care Medicine, Charité - Universitaetsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
J Cardiothorac Vasc Anesth. 2022 Nov;36(11):4045-4053. doi: 10.1053/j.jvca.2022.06.036. Epub 2022 Jul 2.
The objectives of this study were to evaluate the incidence and to identify risk factors for acute kidney injury (AKI) in neonates undergoing cardiopulmonary bypass (CPB) with a miniaturized bloodless primed extracorporeal circuit.
A retrospective cohort study.
A single-center, tertiary academic hospital.
Data of 462 patients were analyzed.
With a retrospective analysis of neonates undergoing CPB with bloodless priming between May 2007 and August 2019, the incidence of AKI was determined according to the neonatal Kidney Disease: Improving Global Outcomes classification. Multivariate logistic regression analyses were performed to determine risk factors for AKI.
The incidence of AKI was 41.1% (190 of 462); 30.3% (n = 140) had mild stage 1, 6.5% (n = 30) reached stage 2, and 4.3% (n = 20) reached stage 3. Multivariate logistic regression showed that degree of hypothermia (p = 0.05), duration of CPB (p = 0.03), and lower baseline serum creatinine (p < 0.001) were associated independently with AKI. In the authors' patient population, patients without transfusion of donor-derived erythrocytes had a lower incidence of AKI (p = 0.003). AKI stages 2 and 3 were associated with longer duration of mechanical ventilation (p = 0.008) and increased length of stay in the intensive care unit (p = 0.03).
With a miniaturized CPB circuit and bloodless priming, the AKI incidence was well within the range consistent with previously reported studies from other institutions.
本研究旨在评估使用微型无血预充体外循环进行体外循环（CPB）的新生儿发生急性肾损伤（AKI）的发生率，并确定其危险因素。
回顾性队列研究。
单中心、三级学术医院。
分析了 462 名患者的数据。
通过对 2007 年 5 月至 2019 年 8 月期间接受无血预充 CPB 的新生儿进行回顾性分析，根据新生儿肾脏病：改善全球结局分类确定 AKI 的发生率。采用多变量逻辑回归分析确定 AKI 的危险因素。
AKI 的发生率为 41.1%（462 例中有 190 例）；30.3%（n=140）为轻度 1 期，6.5%（n=30）达到 2 期，4.3%（n=20）达到 3 期。多变量逻辑回归显示，低体温程度（p=0.05）、CPB 持续时间（p=0.03）和较低的基线血清肌酐（p<0.001）与 AKI 独立相关。在作者的患者人群中，未输注供体来源红细胞的患者 AKI 发生率较低（p=0.003）。AKI 2 期和 3 期与更长的机械通气时间（p=0.008）和重症监护病房住院时间延长（p=0.03）相关。
使用微型 CPB 回路和无血预充，AKI 的发生率与其他机构先前报道的研究结果一致。
