心不停跳心内直视术体外循环初期低血压对肾功能的影响

摘要

目的:探讨体外循环(cardiopulmonary bypass,CPB)初期低血压对肾功能的影响.方法:择期行心不停跳二尖瓣置换术患者42例,随机分为观察组(D组)和对照组(C组),两组CPB开始时平均动脉压(mean arterial pressure,MAP)在5.33～8.67kPa,MAP≥8.67 kPa剔除,观察中D组和C组各有1例退出研究,最终每组20例,D组转流15 min内MAP在5.33～8.67kPa,C组转流15 min内MAP在8.67～10.67 kPa.两组患者分别于手术前(T0)、手术结束(T1)、术后6 h(T2)、12 h(T3)、24 h(T4)、48 h(T5)采集静脉血,用于检测肌酐(SCr)、尿素氮(BUN)、α1微球蛋白(α1-MG)的水平.结果:与T0比较,T3、T4时点C组BUN升高(P＜0.01),T2、T3、T4、T5时点D组BUN升高(P＜0.01),T3、T4、T5时点C组SCr升高(P＜0.05或P＜0.01),T2、T3、T4、T5时点D组SCr升高(P＜0.01),T2、T3时点C组α1-MG升高(P＜0.05或P＜0.01),T2、T3、T4时点D组α1-MG升高(P＜0.05或P＜0.01).与C组比较,T5时点D组BUN升高(P＜0.05),T2、T5时点D组SCr升高(P＜0.05),T1、T2时点D组α1-MG升高(P＜0.05).两组患者围术期均未发现血红蛋白尿,都没有发生术后急性肾功能衰竭.结论:心不停跳心内直视术CPB初期不同血压水平对术后肾功能均有影响,以CPB初期低血压对患者肾功能影响较大.%Objective:To investigate the effects of the initial hypotension on renal function in patients underwent cardiopulmonary bypass with beating heart operation.Methods:The patients underwent mitral valve replacement with beating heart,and with the mean arterial pressure (MAP) between 5.33 and 8.67 kPa within 15 minutes at the beginning cardiopulmonary bypass were included in this experiment.Forty-two patients were randomly divided into two groups.For group D,the MAP of twenty patients was between 5.33 and 8.67 kPa within 15 minutes at the beginning cardiopulmonary bypass,after 15 minutes the MAP was between 8.67 and 10.67 kPa.For group C,through improving perfusion index and giving phenylephrine in necessity,the MAP of twenty patients was between 8.67 and 10.67 kPa within 15 minutes at the beginning cardiopulmonary bypass,after 15 minutes the MAP was between 8.67 and 10.67 kPa.Each group had a case that didn't comply with the conditions,withdrew from the study.Venous blood samples of the two groups' patients were taken before operation (T0),immediately (T1),6 h (T2),12 h (T3),24 h (T4) and 48 h (T5) after the end of operation for determination the concentrations of the serum urea nitrogen,serum creatinine and α1 microglobulin.Results:Compared with T0,the concentrations of the serum urea nitrogen in group C were significantly increased at T3 and T4 (P＜0.01),the concentrations of the serum urea nitrogen in group D were significantly increased at T2,T3,T4 and T5 (P＜ 0.01),the concentrations of the serum creatinine in group C were significantly increased at T3,T4 and T5 (P＜0.05 or P＜0.01),the concentrations of the serum creatinine in group D were significantly increased at T2,T3,T4 and T5 (P＜0.01),the concentrations of α1 microglobulin in group C were significantly increased at T2 and T3 (P＜0.05 or P＜0.01),the concentrations of α1 microglobulin in group D were significantly increased at T2,T3 and T4 (P＜0.05 or P＜0.01).The concentrations of the serum urea nitrogen at T5 were significantly higher in group D than in group C,the concentrations of the serum creatinine at T2 and T5 were significantly higher in group D than in group C (P＜0.05),the concentrations of α1 microglobulin at T1 and T2 were significantly higher in group D than in group C (P＜0.05).All patients of the two groups were not found hemoglobinuria during perioperative,and didn't occur postoperative acute renal failure.Conclusion:The patients with initial hypotension within 15 minutes at the beginning cardiopulmonary bypass have adverse influence on renal function.