He Linling, Liang Silin, Liang Yu, Fang Miaoxian, Li Jiaxin, Deng Jia, Fang Heng, Li Ying, Jiang Xinyi, Chen Chunbo
Department of Intensive Care Unit of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 96 Dongchuan Road, Guangzhou, 510080, China.
Shantou University Medical College, Shantou, 515000, China.
Intern Emerg Med. 2023 Mar;18(2):439-448. doi: 10.1007/s11739-022-03187-3. Epub 2022 Dec 29.
Acute kidney injury (AKI) is a common but fatal complication after cardiac surgery. In the absence of effective treatments, the identification and modification of risk factors has been a major component of disease management. However, the optimal blood pressure target for preventing cardiac surgery-associated acute kidney injury (CSA-AKI) remains unclear. We sought to determine the effect of postoperative mean arterial pressure (MAP) in CSA-AKI. It is hypothesized that longer periods of hypotension after cardiac surgery are associated with an increased risk of AKI. This prospective cohort study was conducted on adult patients who underwent cardiac surgery requiring cardiopulmonary bypass at a tertiary center between October 2018 and May 2020. The primary outcome is the occurrence of CSA-AKI. MAP and its duration in the ranges of less than 65, 65 to 74, and 75 to 84 mmHg within 24 h after surgery were recorded. The association between postoperative MAP and CSA-AKI was examined by using logistic regression. Among the 353 patients enrolled, 217 (61.5%) had a confirmed diagnosis of CSA-AKI. Each 1 h epoch of postoperative MAP less than 65 mmHg was associated with an adjusted odds ratio of 1.208 (95% CI, 1.007 to 1.449; P = 0.042), and each 1 h epoch of postoperative MAP between 65 and 74 mmHg was associated with an adjusted odds ratio of 1.144 (95% CI, 1.026 to 1.275; P = 0.016) for CSA-AKI. A potentially modifiable risk factor, postoperative MAP less than 75 mmHg for 1 h or more is associated with an increased risk of CSA-AKI.
急性肾损伤（AKI）是心脏手术后常见但致命的并发症。在缺乏有效治疗方法的情况下，识别和改变风险因素一直是疾病管理的主要组成部分。然而，预防心脏手术相关急性肾损伤（CSA-AKI）的最佳血压目标仍不明确。我们试图确定术后平均动脉压（MAP）对CSA-AKI的影响。据推测，心脏手术后较长时间的低血压与AKI风险增加有关。这项前瞻性队列研究针对2018年10月至2020年5月在一家三级中心接受需要体外循环的心脏手术的成年患者进行。主要结局是CSA-AKI的发生。记录术后24小时内MAP及其在低于65、65至74以及75至84 mmHg范围内的持续时间。采用逻辑回归分析术后MAP与CSA-AKI之间的关联。在纳入的353例患者中，217例（61.5%）确诊为CSA-AKI。术后MAP每低于65 mmHg 1小时，调整后的比值比为1.208（95%CI，1.007至1.449；P = 0.042），术后MAP在65至74 mmHg之间每1小时，CSA-AKI的调整后比值比为1.144（95%CI，1.026至1.275；P = 0.016）。一个可能可改变的风险因素，即术后MAP低于75 mmHg持续1小时或更长时间，与CSA-AKI风险增加有关。
