Wider intraoperative glycemic fluctuation increases risk of acute kidney injury after pediatric cardiac surgery.
Wider intraoperative glycemic fluctuation increases risk of acute kidney injury after pediatric cardiac surgery.
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DOI：
10.1080/0886022x.2018.1532908
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发表时间：
2018-11
期刊：
影响因子：
3
通讯作者：
Duan YY
中科院分区：
文献类型：
--
作者：
Hu GH;Duan L;Jiang M;Zhang CL;Duan YY
目的：已观察到成人心脏手术中术中血糖控制不良与术后急性肾损伤（阿基）之间的相关性，但儿科数据仍未知。我们假设术中高血糖和/或更大范围的血糖波动与小儿心脏手术术后阿基的发生率相关。方法：对2013年至2016年接受心脏手术的儿科患者进行回顾性研究。收集并分析术后48小时的围手术期血糖数据。根据倾向评分，阿基患者与非阿基患者1：1匹配。人口统计学数据、术前肾功能和血糖水平、围术期心脏状况等变量均匹配。结果如下：阿基的发生率为11.5%（118/1026），分别有53.4%（63/118）、30.5%（36/118）和16.1%（19/118）归类为AKIN I、II和III期。发生阿基的儿童年龄更小，出现紫绀，接受了更复杂的手术，术中葡萄糖峰值水平更高，术中血糖波动范围更广，变力性评分更高，输血次数更多，结局较差（所有p <0.05）。匹配后，阿基组的术中血糖波动明显更大（p <0.05）。Logistic回归分析显示，术中血糖波动是阿基的危险因素之一（p = 0.033），并且随着血糖波动的增加，阿基的严重程度分级也增加（p <0.01）。结论：更广泛的术中血糖波动，而不是高血糖，与儿科心脏手术后术后阿基的发生率增加有关。
Objective: The association between poor intraoperative glycemic control and postoperative acute kidney injury (AKI) in adult cardiac surgery has been observed, but data in the pediatrics remain unknown. We performed a hypothesis that intraoperative hyperglycemia and/or wider glycemic fluctuation were associated with the incidence of postoperative AKI in pediatric cardiac surgery. Methods: A retrospective study was performed in pediatrics who underwent cardiac surgery from 2013 to 2016. Perioperative glycemic data up to 48 hours after surgery were collected and analyzed. Patients with AKI were matched 1:1 with patients without AKI by a propensity score. Variables of demographic data, preoperative renal function and glycemic level, perioperative cardiac condition were matched. Results: The incidence of AKI was 11.5% (118/1026), with 53.4% (63/118), 30.5% (36/118), and 16.1% (19/118) categorized as AKIN stages I, II, and III, respectively. Children who experienced AKI were younger and cyanotic, underwent more complex surgeries, had higher peak intraoperative glucose levels, wider intraoperative glycemic fluctuation, greater inotropic scores and more transfusions, and poor outcomes (all p < .05). After matching, the AKI group had significantly wider intraoperative glycemic fluctuation (p < .05). Logistic regression showed intraoperative glycemic fluctuation was one of the risk factors for AKI (p = .033) and degree of AKI severity stage increased when the glycemic fluctuation increased (p < .01). Conclusions: Wider intraoperative glycemic fluctuation, but not hyperglycemia, was associated with an increased incidence of postoperative AKI after pediatric cardiac surgery.