Peng Ling, Zheng Yeying, Guo Fei, Su Mengdan, Wei Wei
Department of Anesthesiology, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041, China.
Department of Anesthesiology, Zigong Fourth People's Hospital, Zigong, 643099, China.
J Cardiothorac Surg. 2025 Jan 9;20(1):48. doi: 10.1186/s13019-024-03312-7.
Near-infrared spectroscopy (NIRS) enables a non-invasive measurement of tissue oxygen saturation (StO) in regions illuminated by near-infrared lights. Vascular occlusion test (VOT) serves as a model to artificially induce forearm ischemia-reperfusion. The combination of StO monitoring and VOT allows for dynamic evaluation of the balance between oxygen delivery and consumption in tissue, as well as the functional reserve of microcirculation. However, the implications of these measurements for patient outcomes remain inadequately understood. This study aimed to investigate the association between StO-VOT measurements and the occurrence of postoperative acute kidney injury (AKI), in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB).
Between March 2020 and March 2021, 100 adult patients who scheduled to undergo cardiac surgery with mild hypothermic CPB were enrolled to this prospective observational study. StO was continuously monitored at the right forearm and ipsilateral VOT procedure was performed before initiation of CPB, at the time before weaning from CPB, and at the end of surgery. Preoperative and intraoperative factors, along with StO-VOT parameters, were evaluated for their independent association with the occurrence of AKI following cardiac surgery. StO-VOT parameters were also compared between patients with hyperlactatemia (peak blood lactate ≥ 4 mmol/L) and those without hyperlactatemia.
In our patient population (n = 87), 13.79% (12/87) patients developed AKI after surgery. Multivariable analysis revealed that CPB time and post-CPB desaturation speed (D-speed) were independently associated with AKI. Post-CPB D-speed had an area under receiver operating characteristic (ROC) curve of 0.79 (95% CI, 0.66-0.93) with a cutoff value of 0.08%·min in predicting AKI. Patients with hyperlactatemia had longer pre-CPB T and higher D-speed during CPB. However, ROC analysis indicated that T and D-speed exhibited limited predictive capacity for hyperlactatemia. Patients with AKI exhibited an increased risk of prolonged ICU stays, postoperative stroke, reoperation, and in-hospital mortality.
NIRS monitoring combined with VOT shows promise in predicting postoperative AKI in patients undergoing cardiac surgery with mild hypothermic CPB.
ChiCTR1900021436 with registered date 21/02/2019.
近红外光谱（NIRS）能够对近红外光照射区域的组织氧饱和度（StO）进行无创测量。血管闭塞试验（VOT）可作为人为诱导前臂缺血再灌注的模型。StO监测与VOT相结合，能够动态评估组织中氧输送与消耗之间的平衡，以及微循环的功能储备。然而，这些测量结果对患者预后的影响仍未得到充分理解。本研究旨在调查接受体外循环（CPB）心脏手术患者的StO-VOT测量值与术后急性肾损伤（AKI）发生之间的关联。
在2020年3月至2021年3月期间，100例计划接受轻度低温CPB心脏手术的成年患者被纳入这项前瞻性观察研究。在右前臂持续监测StO，并在CPB开始前、脱离CPB时以及手术结束时进行同侧VOT操作。评估术前和术中因素以及StO-VOT参数与心脏手术后AKI发生的独立关联。还比较了高乳酸血症（血乳酸峰值≥4 mmol/L）患者和无高乳酸血症患者之间的StO-VOT参数。
在我们的患者群体（n = 87）中，13.79%（12/87）的患者术后发生AKI。多变量分析显示，CPB时间和CPB后去饱和速度（D速度）与AKI独立相关。CPB后D速度在预测AKI时的受试者操作特征（ROC）曲线下面积为0.79（95% CI，0.66 - 0.93），截断值为0.08%·min。高乳酸血症患者CPB前的T时间更长，CPB期间的D速度更高。然而，ROC分析表明，T时间和D速度对高乳酸血症的预测能力有限。发生AKI的患者延长ICU住院时间、术后中风、再次手术和院内死亡的风险增加。
NIRS监测与VOT相结合在预测接受轻度低温CPB心脏手术患者术后AKI方面显示出前景。
ChiCTR1900021436，注册日期为2019年2月21日。
