婴幼儿先天性心脏病术后急性肾损伤和液体超负荷相关危险因素分析

摘要

目的 探讨婴幼儿先天性心脏病(CHD)术后急性肾损伤(AKI)和液体超负荷(FOL)的临床危险因素.方法 选择2012年5月～2016年5月在上饶市第五人民医院心脏外科住院,年龄≤2岁,行体外循环(CPB)手术的CHD患儿共95例.记录术后3d的血清肌酐水平,依据急性肾损伤网络工作小组(AKIN)诊断标准确定AKI发生率并分组.收集术前、术中、术后的变量并作为AKI的风险因素进行单变量和多因素Logistic回归分析.记录术后24、48、72 h的FOL,分析AKI和FOL对住院时间,术后机械通气时间和死亡率的影响.结果 AKI发生率为45％其中,AKI 1级占87％.多因素Logistic回归分析显示,基础肌酐值、选择性脑灌注、CPB时间和血管活性药物评分与AKI独立相关(P＜0.05).总共8例患儿死亡,其中AKI 1级(轻度)5例,AKI 2级(中度)3例.单因素分析显示,AKI组对比无AKI组住院时间、机械通气时间、死亡率均增加,差异有统计学意义(P＜0.05).术后72 hFOL≤15％ 62例,FOL＞15％ 33例.FOL＞ 15％组的婴幼儿相比FOL≤15％组的婴幼儿住院时间、机械通气时间、死亡率均增加,差异有统计学意义(P＜0.05).结论 CPB持续时间、基础肌酐值、选择性脑灌注、血管活性药物评分与婴幼儿先天性心脏病术后AKI呈独立相关;术后发生AKI和FOL均增加住院时间、机械通气时间和死亡率.%Objective To investigate the clinical risk factors of acute kidney injury (AKI) and fluid overload (FOL) in infants after congenital heart disease (CHD) surgery.Methods Date of 95 patients aged ≤2 years underwent CPB surgery for CHD were reviewed retrospectively from May 2012 to May 2016.The serum creatinine level was recorded for 3 days after surgery.According to the AKIN standard of AKI,patients were divided into two groups:AKI group and non-AKI group.Preoperative,intraoperative and postoperative variables were collected and analyzed as the potential risk factors of AKI.Percentage FOL was recorded cumulatively at 24,48,and 72 h after surgery.The influence of AKI and FOL on hospital length of stay,postoperative mechanical ventilation days,and mortality were analyzed.Results The incidence of infants AKI was 45％,of which 87％ had AKI at stage I.Multivariate Logistic regression analysis showed factors association with cardiopulmonary bypass time,selective cerebral perfusion,preoperative creatinine value and vasoactive drugs score independently respectively (P ＜ 0.05).A total of 8 patients died (5 cases of AKI of stage 1,3cases of AKI of stage 2).Single factor analysis showed that patients of the AKI group had longer hospital stay,ventilator days,and a higher mortality rate than the non-AKI group (P ＜ 0.05).FOL of 62 infants were ≤ 15％ in the first 72 h after surgery,FOL of 33 infants were ＞15％.Infants with FOL ＞15％ had longer hospital stay,ventilator days,and a higher mortality rate than infants with FOL ≤ 15％ FOL group (P ＜ 0.05).Conclusion CPB duration,selective cerebral perfusion,preoperative creatinine value and vasoactive drugs score are relative risk factors of AKI after CHD surgery with CPB in infants.Postoperative AKI and FOL increased hospital stay,mechanical ventilation time and mortality.