Service d'Anesthésie-Réanimation, Hôpital Louis Pradel, Hospices Civils de Lyon, Bron Cedex, France.
Service de Chirurgie Cardiovasculaire de l'Adulte, Hôpital Louis Pradel, Hospices Civils de Lyon, Bron Cedex, France; Laboratoire RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon Cedex, France.
J Cardiothorac Vasc Anesth. 2024 Oct;38(10):2213-2220. doi: 10.1053/j.jvca.2024.07.019. Epub 2024 Jul 11.
Cardiac surgery associated-acute kidney injury is a common and serious postoperative complication of cardiac surgery, which is associated with increased postoperative morbidity and mortality. This study aimed to explore the association between cardiopulmonary bypass (CPB) blood flow rate (BFR), and major adverse kidney events (MAKEs) at day 30.
Retrospective single-center before-after observational study. Patients were divided in 2 groups according to CPB flow rates: a first group with an institutional protocol targeting a CPB-BFR of >2.2 L/min/m² (low CPB-BFR group), and a second group with a modified institutional protocol targeting a CPB-BFR of >2.4 L/min/m² (high CPB-BFR group). The primary outcome was MAKE at 30 days, defined as the composite of death, renal replacement therapy or persistent renal dysfunction.
The data were collected from clinical routines in university hospital.
Adult patients who underwent elective and urgent cardiac surgery without severe chronic renal failure, for whom CPB duration was ≥90 minutes.
We included 533 patients (low CPB-BFR group, n = 270; high CPB-BFR group, n = 263).
A significant decrease in MAKE at 30 days was observed in the high CPB-BFR group (3% v 8%; odds ratio [OR], 0.779; 95% confidence interval [CI], 0.661-0.919; p < 0.001) mainly mediated by a lower 30-day mortality in the high CPB-BFR group (1% v 5%; OR, 0.697; 95% CI, 0.595-0.817; p = 0.001), as was renal replacement therapy (1% v 4%; OR, 0.739; 95% CI, 0.604-0.904; p = 0.016).
In patients undergoing cardiac surgery, increased CPB-BFR was associated with a decrease in MAKE at 30 days including mortality and renal replacement therapy.
心脏手术相关急性肾损伤是心脏手术后常见且严重的术后并发症，与术后发病率和死亡率增加相关。本研究旨在探讨体外循环（CPB）血流速率（BFR）与术后 30 天主要不良肾脏事件（MAKEs）之间的关系。
回顾性单中心前后观察性研究。根据 CPB 流速将患者分为两组：一组采用机构方案，目标 CPB-BFR＞2.2 L/min/m²（低 CPB-BFR 组），另一组采用改良机构方案，目标 CPB-BFR＞2.4 L/min/m²（高 CPB-BFR 组）。主要结局为术后 30 天的 MAKE，定义为死亡、肾脏替代治疗或持续肾功能障碍的复合事件。
数据来自大学医院的临床常规收集。
接受择期和紧急心脏手术且无严重慢性肾衰竭的成年患者，CPB 时间≥90 分钟。
共纳入 533 例患者（低 CPB-BFR 组 270 例，高 CPB-BFR 组 263 例）。
高 CPB-BFR 组术后 30 天 MAKE 显著降低（3%比 8%；比值比[OR]，0.779；95%置信区间[CI]，0.661-0.919；p＜0.001），主要原因是高 CPB-BFR 组 30 天死亡率较低（1%比 5%；OR，0.697；95%CI，0.595-0.817；p=0.001），肾脏替代治疗也较低（1%比 4%；OR，0.739；95%CI，0.604-0.904；p=0.016）。
在接受心脏手术的患者中，CPB-BFR 增加与术后 30 天 MAKE 降低相关，包括死亡率和肾脏替代治疗。
