体外膜肺氧合支持下心内直视术后心源性休克患者急性肾损伤的评估
Evaluation of Acute Kidney Injury in Postcardiotomy Cardiogenic Shock Patients Supported by Extracorporeal Membrane Oxygenation.
作者信息
Qi Jiachen, Yan Weidong, Liu Gang, Teng Yuan, Gao Sizhe, Yan Shujie, Wang Jian, Zhou Boyi, Ji Bingyang
机构信息
Department of Cardiopulmonary Bypass, Fuwai Hospital, National Center for Cardiovascular Disease, State Key Laboratory of Cardiovascular Medicine, Chinese Academy of Medical Science & Peking Union Medical College, 100037 Beijing, China.
Department of Pain Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, 102218 Beijing, China.
出版信息
Rev Cardiovasc Med. 2023 Mar 16;24(3):91. doi: 10.31083/j.rcm2403091. eCollection 2023 Mar.
BACKGROUND
This study sought to evaluate the incidence of acute kidney injury (AKI) defined by the Kidney Disease: Improving Global Outcomes (KDIGO) group in patients supported by veno-arterial extracorporeal membrane oxygenation (VA ECMO) after post-cardiotomy cardiogenic shock (PCS), and to identify the risk factors for AKI 3.
METHODS
Patients with and without AKI 3 were divided into two groups. Potential risk factors for developing AKI 3 were evaluated by univariate logistic regression analysis. Patient risk factors ( 0.1) in the univariate analysis were entered into the multivariable logistic regression model. The tolerance and variance inflation factors (VIF) were calculated to evaluate the collinearity of the potential variables.
RESULTS
136 patients with a mean age of 53.6 13.9 years (66.9% male) were enrolled in the study. 80 patients (58.8%) developed AKI 3. Patients with AKI 3 required significantly longer mechanical ventilation (200.9 [128.0, 534.8] hours 78.9 [13.0, 233.0] hours, 0.001). The ICU stay and hospital stay of patients with AKI 3 were much longer than patients with AKI 3 (384 [182, 648] hours 216 [48, 456] hours, = 0.001; 25.0 [15.3, 46.6] days 13.4 [7.4, 38.4] days, = 0.022, respectively). There was no difference in preoperative risk factors between the two groups. Age, cross-clamp time, cardiopulmonary bypass (CPB) time, the timing of ECMO implantation, mean artery pressure (MAP), lactate concentration before ECMO, and preoperative ejection fraction (EF) were entered into the multivariable analysis. The timing of ECMO implantation was an independent risk factor for AKI 3 ( = 0.036). Intraoperatively implantation of ECMO may decrease the incidence of AKI 3 (odds ratio (OR) = 0.298, 95% confidence interval (CI) = 0.096-0.925). The tolerance and variance inflation factors showed that there was no collinearity among these variables.
CONCLUSIONS
The incidence of AKI 3 in patients supported by VA ECMO after PCS was 58.8% in our center. Patients with AKI 3 required significantly longer mechanical ventilation and hospital stay. Intraoperative implantation VA ECMO was associated with a decreased incidence of AKI 3.
背景
本研究旨在评估心脏术后心源性休克（PCS）后接受静脉 - 动脉体外膜肺氧合（VA ECMO）支持的患者中，由改善全球肾脏病预后组织（KDIGO）定义的急性肾损伤（AKI）的发生率，并确定AKI 3期的危险因素。
方法
将发生和未发生AKI 3期的患者分为两组。通过单因素逻辑回归分析评估发生AKI 3期的潜在危险因素。单因素分析中P<0.1的患者危险因素被纳入多变量逻辑回归模型。计算容忍度和方差膨胀因子（VIF）以评估潜在变量的共线性。
结果
136例患者纳入研究，平均年龄53.6±13.9岁（男性占66.9%）。80例患者（58.8%）发生AKI 3期。发生AKI 3期的患者机械通气时间显著更长（200.9 [128.0, 534.8]小时 vs 78.9 [13.0, 233.0]小时，P<0.001）。AKI 3期患者的ICU住院时间和住院时间比未发生AKI 3期的患者长得多（384 [182, 648]小时 vs 216 [48, 456]小时，P = 0.001；25.0 [15.3, 46.6]天 vs 13.4 [7.4, 38.4]天，P = 0.022）。两组术前危险因素无差异。年龄、主动脉阻断时间、体外循环（CPB）时间、ECMO植入时机、平均动脉压（MAP）、ECMO前乳酸浓度和术前射血分数（EF）被纳入多变量分析。ECMO植入时机是AKI 3期的独立危险因素（P = 0.036）。术中植入ECMO可能降低AKI 3期的发生率（比值比（OR）= 0.298，95%置信区间（CI）= 0.096 - 0.925）。容忍度和方差膨胀因子表明这些变量之间不存在共线性。
结论
在我们中心，PCS后接受VA ECMO支持的患者中AKI 3期的发生率为58.8%。发生AKI 3期的患者需要显著更长的机械通气时间和住院时间。术中植入VA ECMO与AKI 3期发生率降低相关。
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