Long Feng, Zhang Yan, Luo Ming, Liu Ting, Qin Zhen, Wang Bo, Zhou Yiheng, Zhou Ronghua
Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, Sichuan, People's Republic of China.
Department of Clinical Medicine, Henan Medical College of Zhengzhou University, Zhengzhou, People's Republic of China.
Ann Thorac Surg. 2025 Apr;119(4):891-898. doi: 10.1016/j.athoracsur.2024.10.015. Epub 2024 Oct 30.
Although goal-directed perfusion (GDP) during cardiopulmonary bypass (CPB) has been discussed extensively in adult studies, no pediatric indexed oxygen delivery (Doi) thresholds are universally accepted, and no pediatric randomized controlled trial has been reported. This study aimed to determine whether the GDP initiative (maintaining Doi ≥360 mL/min/m during CPB) could reduce the incidence of acute kidney injury (AKI) after pediatric cardiac operation and improve clinical outcomes.
This single-center randomized controlled trial enrolled 312 pediatric patients, who were randomized to receive either the GDP strategy or a conventional perfusion strategy during CPB. The primary outcome was the rate of postoperative AKI. Secondary outcomes included major postoperative complications, all-cause mortality within 30 days, and short-term clinical outcomes after operation.
AKI occurred in 43 patients (28.1%) in the GDP group and in 65 patients (42.2%) in the control group (relative risk, 0.67; 95% CI, 0.49-0.91; P = .010). In the subgroup analysis, the GDP group had a lower AKI rate compared with the control group among patients aged less than 1 year, with a nadir temperature greater than 32 °C and a nadir hemoglobin value less than 8 g/L during CPB, with preoperative cyanosis, and with CPB duration from 60 to 120 minutes.
The GDP strategy aimed at maintaining Doi ≥360 mL/min/m during CPB is effective in reducing the risk of AKI after pediatric cardiac operation.
尽管体外循环（CPB）期间的目标导向灌注（GDP）在成人研究中已得到广泛讨论，但尚无普遍接受的儿科氧输送指数（Doi）阈值，且尚无儿科随机对照试验的报道。本研究旨在确定GDP方案（CPB期间维持Doi≥360 mL/min/m）是否能降低小儿心脏手术后急性肾损伤（AKI）的发生率并改善临床结局。
这项单中心随机对照试验纳入了312例儿科患者，他们在CPB期间被随机分配接受GDP策略或传统灌注策略。主要结局是术后AKI的发生率。次要结局包括术后主要并发症、30天内全因死亡率以及术后短期临床结局。
GDP组有43例患者（28.1%）发生AKI，对照组有65例患者（42.2%）发生AKI（相对风险，0.67；95%CI，0.49 - 0.91；P = 0.010）。在亚组分析中，GDP组在年龄小于1岁、CPB期间最低体温大于32°C、最低血红蛋白值小于8 g/L、术前有发绀以及CPB持续时间为60至120分钟的患者中，AKI发生率低于对照组。
CPB期间旨在维持Doi≥360 mL/min/m的GDP策略可有效降低小儿心脏手术后发生AKI的风险。
