肠和肾局部氧饱和度对先天性心脏病术后患儿急性肾损伤的预测价值。
Prediction value of regional oxygen saturation in intestine and kidney for acute kidney injury in children with congenital heart disease after surgery.
出版信息
Zhejiang Da Xue Xue Bao Yi Xue Ban. 2022 Jun 25;51(3):334-340. doi: 10.3724/zdxbyxb-2022-0069.
OBJECTIVE
To study the prediction value of regional oxygen saturation (rSO ) in brain, intestine and kidney for acute kidney injury (AKI) in children with congenital heart disease after surgery.
METHODS
Fifty-seven children with congenital heart disease (CHD), whose weight >2.5 kg and age≤1 year were treated in Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine from January 2020 to December 2020. The rSO of brain, intestine and kidney were monitored with near-infrared spectroscopy continuously for 48 h after surgery. The predictive values of cerebral, intestinal and renal rSO for occurrence and severity of postoperative AKI were analyzed.
RESULTS
Among 57 patients, postoperative AKI developed in 38 cases (66.7%), including 18 cases of AKI-1 (47.4%), 9 cases of AKI-2 (23.7%) and 11 cases of AKI-3 (28.9%). There was no significant difference in cerebral rSO between AKI group and non-AKI group ( =0.012, >0.05), while the intestinal rSO and renal rSO in AKI group were significantly lower than those in non-AKI group ( =5.017 and 5.003, both <0.05). There was no significant difference in brain rSO between children with or without AKI-2 and above ( =0.311, >0.05), but the intestinal rSO and renal rSO in children with AKI-2 and above were lower than other children ( =6.431 and 14.139, both <0.05). The area under ROC curve (AUC) of intestinal rSO 3 h after surgery for predicting AKI was 0.823, and with intestinal rSO 3 h after surgery <85%, the sensitivity and specificity were 66.7% and 89.5%, respectively. The AUC of renal rSO for the diagnosis of AKI at 31 h after surgery was 0.918, and with intestinal rSO 31 h after surgery <84%, the sensitivity and specificity were 72.2% and 84.2%, respectively. The AUC of intestinal rSO 3 h after surgery for the diagnosis of AKI-2 and above was 0.829, and with intestinal rSO 3 h after surgery <84%, the sensitivity and specificity were 62.2% and 90.0%, respectively. The AUC of renal rSO for the diagnosis of AKI-2 and above was 0.826 at 34 h postoperatively, and with intestinal rSO 34 h after surgery <71%, the sensitivity and specificity were 91.9% and 55.0%, respectively.
CONCLUSION
The monitoring of intestinal and renal rSO can predict the occurrence and severity of postoperative AKI in children with congenital heart disease after surgery.
目的
研究脑、肠、肾局部氧饱和度（rSO ）对先天性心脏病（CHD）术后儿童急性肾损伤（AKI）的预测价值。
方法
选取 2020 年 1 月至 2020 年 12 月上海交通大学医学院附属上海儿童医学中心收治的 57 例体重>2.5kg、年龄≤1 岁的 CHD 患儿，术后连续 48h 采用近红外光谱仪监测脑、肠、肾 rSO 。分析脑、肠、肾 rSO 对术后 AKI 发生及严重程度的预测价值。
结果
57 例患儿术后发生 AKI 38 例（66.7%），其中 AKI-1 18 例（47.4%）、AKI-2 9 例（23.7%）、AKI-3 11 例（28.9%）。AKI 组与非 AKI 组患儿脑 rSO 比较，差异无统计学意义（ =0.012，>0.05），肠 rSO 、肾 rSO 均低于非 AKI 组（ =5.017、5.003，均<0.05）。AKI-2 及以上 AKI 患儿脑 rSO 与 AKI-2 以下 AKI 患儿比较，差异无统计学意义（ =0.311，>0.05），肠 rSO 、肾 rSO 均低于 AKI-2 以下 AKI 患儿（ =6.431、14.139，均<0.05）。术后 3h 肠 rSO 预测 AKI 的 ROC 曲线下面积（AUC）为 0.823，肠 rSO 3h<85%时，灵敏度和特异度分别为 66.7%、89.5%。术后 31h 肾 rSO 预测 AKI 的 AUC 为 0.918，肾 rSO 31h<84%时，灵敏度和特异度分别为 72.2%、84.2%。术后 3h 肠 rSO 预测 AKI-2 及以上 AKI 的 AUC 为 0.829，肠 rSO 3h<84%时，灵敏度和特异度分别为 62.2%、90.0%。术后 34h 肾 rSO 预测 AKI-2 及以上 AKI 的 AUC 为 0.826，肾 rSO 34h<71%时，灵敏度和特异度分别为 91.9%、55.0%。
结论
监测肠、肾 rSO 可预测先天性心脏病患儿术后 AKI 的发生和严重程度。
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