Liu M H, Zhang Y, Luo M, Liu T, Long F, Zhou R H
Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu 610041, China.
Zhonghua Yi Xue Za Zhi. 2023 Dec 26;103(48):3909-3916. doi: 10.3760/cma.j.cn112137-20231012-00714.
To explore the correlation of the ratio of venous-arterial carbon dioxide (CO) tension difference to arterial-venous O content difference (Pv-aCO/Ca-vO) and venous-arterial CO gradient (Pv-aCO) during cardiopulmonary bypass (CPB) with acute kidney injury (AKI) after pediatric cardiac surgery. The clinical data of children (1 month ≤ age ≤ 3 years old) who underwent open heart surgery under CPB in West China Hospital of Sichuan University from March 2021 to August 2022 were retrospectively analyzed. All paired blood gases of the children during CPB (the sampling time interval of arterial and venous blood was within 10 minutes) were collected. According to the Failure, Loss, End-Stage Renal Disease (pRIFLE) diagnostic criteria, the children were divided into AKI group and non-AKI group. Multivariate logistic regression analysis was performed to identify the risk factors of postoperative AKI in pediatric cardiac surgery. A total of 213 children were enrolled (101 males and 112 females), aged 12(6, 24) months, and 84 of them (39.4%) developed AKI. Three children died in AKI group, with a mortality of 3.6%. There were no deaths in non-AKI group. The incidence of postoperative low cardiac output syndrome (LCOS) was higher in AKI group [29.8% (25/84) vs 7.0% (9/129), <0.001]. In addition, compared with the non-AKI group, children in AKI group had longer recovery time [15 (6, 78) h vs 6 (3, 19) h, <0.001], mechanical ventilation time [17 (7, 97) h vs 6 (4, 20) h, <0.001], intensive care unit (ICU) stay [6 (4, 11) d vs 3 (2, 5) d, <0.001], and hospital stay [12 (9, 18) d vs 9 (8, 11) d, <0.001]. A total of 317 arterial and venous blood gas pairs from 30 (=207), 60 (=75) and 90 min (=35) after aortic clamping were included in the analysis. Univariate analysis showed that Pv-aCO/Ca-vO (=0.015) at 30 min after aortic clamping, Pv-aCO (=0.041) and Pv-aCO/Ca-vO (=0.014) at 60 min after aortic clamping, peak Pv-aCO (=0.009), peak Pv-aCO/Ca-vO (<0.001) and the average value of Pv-aCO/Ca-vO (=0.001) were higher in AKI group. Multivariate logistic regression analysis showed that longer duration of CPB (=1.013, 95%: 1.003-1.023, =0.012), higher peak Pv-aCO/Ca-vO (=1.337, 95%: 1.037-1.723, =0.025) were risk factors for AKI. The occurrence of AKI after pediatric cardiac surgery is related to the short-term adverse clinical prognosis, and longer duration of CPB and higher peak Pv-aCOCa-vO are independent risk factors for AKI.
探讨小儿心脏手术体外循环（CPB）期间静脉 - 动脉二氧化碳（CO）分压差值与动脉 - 静脉氧含量差值之比（Pv - aCO₂/Ca - vO₂）及静脉 - 动脉CO梯度（Pv - aCO₂）与急性肾损伤（AKI）的相关性。回顾性分析2021年3月至2022年8月在四川大学华西医院接受CPB下心脏直视手术的1个月≤年龄≤3岁儿童的临床资料。收集患儿CPB期间所有配对血气（动脉血与静脉血采样时间间隔在10分钟内）。根据急性肾损伤网络（AKIN）诊断标准，将患儿分为AKI组和非AKI组。采用多因素logistic回归分析确定小儿心脏手术术后AKI的危险因素。共纳入213例患儿（男101例，女112例），年龄12（6，24）个月，其中84例（39.4%）发生AKI。AKI组3例死亡，死亡率为3.6%。非AKI组无死亡病例。AKI组术后低心排血量综合征（LCOS）发生率更高[29.8%（25/84）比7.0%（9/129），P<0.001]。此外，与非AKI组相比，AKI组患儿恢复时间更长[15（6，78）小时比6（3，19）小时，P<0.001]、机械通气时间更长[17（7，97）小时比6（4，20）小时，P<0.001]、重症监护病房（ICU）住院时间更长[6（4，11）天比3（2，5）天，P<0.001]、住院时间更长[12（9，18）天比9（8，11）天，P<0.001]。分析包括主动脉阻断后30分钟（n = 207）、60分钟（n = 75）和90分钟（n = 35）的317对动脉和静脉血气。单因素分析显示，主动脉阻断后30分钟的Pv - aCO₂/Ca - vO₂（P = 0.015）、60分钟的Pv - aCO₂（P = 0.041）和Pv - aCO₂/Ca - vO₂（P = 0.014）、Pv - aCO₂峰值（P = 0.009）、Pv - aCO₂/Ca - vO₂峰值（P<0.001）及Pv - aCO₂/Ca - vO₂平均值（P = 0.001）在AKI组更高。多因素logistic回归分析显示，CPB时间更长（P = 1.013，95%CI：1.003 - 1.023，P = 0.012）、Pv - aCO₂/Ca - vO₂峰值更高（P = 1.337，95%CI：1.037 - 1.723，P = 0.025）是AKI的危险因素。小儿心脏手术后AKI的发生与短期不良临床预后相关，CPB时间更长及Pv - aCO₂/Ca - vO₂峰值更高是AKI的独立危险因素。
