Schaer Dominik J, Schaer Christian A, Humar Rok, Vallelian Florence, Henderson Reney, Tanaka Kenichi A, Levy Jerrold H, Buehler Paul W
Department of Internal Medicine, University Hospital and University of Zurich, Zurich, Switzerland.
Institute of Anesthesiology, University Hospital and University of Zurich, Zurich, Switzerland.
Anesthesiology. 2024 Dec 1;141(6):1162-1174. doi: 10.1097/ALN.0000000000005109.
Acute kidney injury (AKI) affects 20% to 30% of patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). This review synthesizes clinical evidence indicating that CPB-induced hemolysis plays a pivotal role in the development of AKI. The pathogenesis involves cell-free hemoglobin, which triggers oxidative stress, depletes nitric oxide, and incites inflammation, culminating in renal damage. We highlight emerging interventions, including haptoglobin administration, nitric oxide supplementation, and antioxidants, which are promising in reducing the toxicity of cell-free hemoglobin and the incidence of AKI. Current clinical data support the potential efficacy of these treatments. Our analysis concludes that sufficient proof of concept exists to further develop and test these targeted therapies for preventing hemoglobin-induced AKI in patients undergoing CPB.
急性肾损伤（AKI）影响20%至30%接受体外循环（CPB）心脏手术的患者。本综述综合了临床证据，表明CPB诱导的溶血在AKI的发生发展中起关键作用。其发病机制涉及游离血红蛋白，它会引发氧化应激、消耗一氧化氮并引发炎症，最终导致肾损伤。我们重点介绍了新出现的干预措施，包括给予触珠蛋白、补充一氧化氮和使用抗氧化剂，这些措施在降低游离血红蛋白的毒性和AKI的发生率方面很有前景。目前的临床数据支持这些治疗方法的潜在疗效。我们的分析得出结论，有足够的概念验证证据来进一步开发和测试这些靶向治疗方法，以预防接受CPB的患者发生血红蛋白诱导的AKI。
