Regragui I A, Izzat M B, Birdi I, Lapsley M, Bryan A J, Angelini G D
Department of Cardiac Surgery, University of Bristol, United Kingdom.
Ann Thorac Surg. 1995 Jul;60(1):160-4.
The recent introduction of normothermic cardiopulmonary bypass (CPB) perfusion has raised concerns regarding the associated risk of renal dysfunction through its potential to exacerbate the systemic inflammatory response and end-organ injury. This study was designed to investigate the influence of CPB perfusion temperature on renal function.
A prospective, randomized, controlled trial of CPB perfusion temperature (28 degrees C, 32 degrees C, and 37 degrees C) was performed in 30 patients undergoing routine coronary artery bypass grafting with normal preoperative renal function. Creatinine clearance was measured before induction of anesthesia, during CPB, and during every 12-hour period thereafter for 48 hours postoperatively. Glomerular and tubular function were assessed further by measurement of urinary creatinine, albumin, total protein, and retinol binding protein levels preoperatively, during CPB, and on days 1 and 3 postoperatively.
Creatinine clearance increased on CPB by 51% (28 degrees C), 185% (32 degrees C), and 112% (37 degrees C) (all p < 0.01 versus preoperative values) and returned to preoperative values by 24 hours postoperatively in all three groups. Urinary albumin/creatinine ratios rose significantly from a mean of 0.4 +/- 0.1 (standard deviation) to 10 +/- 12.5 (28 degrees C), from 0.55 +/- 0.3 to 5.2 +/- 4.9 (32 degrees C), and from 0.96 +/- 0.8 to 7.8 +/- 7.0 (37 degrees C) during CPB (all p < 0.001) but decreased gradually thereafter. Also, urinary total protein/creatinine ratios rose significantly from a mean of 0.009 +/- 0.007 to 0.034 +/- 0.02 (28 degrees C), from 0.01 +/- 0.006 to 0.026 +/- 0.01 (32 degrees C), and from 0.011 +/- 0.008 to 0.033 +/- 0.02 (37 degrees C) during CPB (all p < 0.005); however, there was a further increase by 24 hours, and ratios decreased gradually thereafter. Similarly, urinary retinol binding protein/creatinine ratios rose significantly in all three groups during CPB (all p < 0.0001) and increased further by 24 hours. There was no statistically significant difference between the renal markers in the three temperature groups in any of the observations.
These data suggest that cardiopulmonary bypass perfusion temperature does not influence renal function in patients undergoing coronary artery bypass grafting.
近期引入的常温体外循环（CPB）灌注引发了人们对其可能加剧全身炎症反应和终末器官损伤从而导致肾功能障碍相关风险的担忧。本研究旨在调查CPB灌注温度对肾功能的影响。
对30例术前肾功能正常且接受常规冠状动脉搭桥术的患者进行了一项关于CPB灌注温度（28摄氏度、32摄氏度和37摄氏度）的前瞻性、随机、对照试验。在麻醉诱导前、CPB期间以及术后48小时内每12小时测量一次肌酐清除率。术前、CPB期间以及术后第1天和第3天通过测量尿肌酐、白蛋白、总蛋白和视黄醇结合蛋白水平进一步评估肾小球和肾小管功能。
CPB期间肌酐清除率在28摄氏度组增加了51%，32摄氏度组增加了185%，37摄氏度组增加了112%（与术前值相比，均p < 0.01），且所有三组在术后24小时均恢复到术前值。CPB期间尿白蛋白/肌酐比值显著升高，从平均0.4±0.1（标准差）升至28摄氏度组的10±12.5，从0.55±0.3升至32摄氏度组的5.2±4.9，从0.96±0.8升至37摄氏度组的7.8±7.0（均p < 0.001），但此后逐渐下降。此外，CPB期间尿总蛋白/肌酐比值也显著升高，从平均0.009±0.007升至28摄氏度组的0.034±0.02，从0.01±0.006升至32摄氏度组的0.026±在所有观察中，三个温度组的肾脏标志物之间均无统计学显著差异。
这些数据表明，体外循环灌注温度对接受冠状动脉搭桥术患者的肾功能没有影响。 01，从0.011±0.008升至37摄氏度组的0.033±0.02（均p < 0.005）；然而，24小时时进一步升高，此后比值逐渐下降。同样，所有三组在CPB期间尿视黄醇结合蛋白/肌酐比值均显著升高（均p < 0.0001），并在24小时时进一步升高。
