Oxygen delivery during cardiopulmonary bypass and acute renal failure after coronary operations
Oxygen delivery during cardiopulmonary bypass and acute renal failure after coronary operations
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DOI：
10.1016/j.athoracsur.2005.05.069
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发表时间：
2005-12-01
影响因子：
4.6
通讯作者：
Ditta, A
中科院分区：
文献类型：
--
作者：
Ranucci, M;Romitti, F;Ditta, A
背景资料。体外循环期间血液稀释的程度最近被确定为心脏手术后急性肾功能衰竭的独立危险因素。在这项前瞻性观察研究中，我们调查了体外循环期间最低氧输送、最低红细胞压积和泵流量作为急性肾功能衰竭和肾功能不全的可能危险因素的作用。对1,048名连续接受冠状动脉手术的患者进行了研究。对于每个患者，我们记录了体外循环中最低的红细胞压积，相应的最低氧气输送，以及在这些测定时间附近的泵流量。这三个变量已在多变量模型中作为急性肾功能衰竭和术后血清肌酐水平升高的可能危险因素进行了探索。输血在确定急性肾功能衰竭中的作用随后被包括在模型中。最好的预测急性肾功能衰竭和术后峰值血肌酐水平的指标是最低的氧输送，临界值为272毫升。分钟(-1)。M(-2)。最低的红细胞压积是一个独立的危险因素，在26%的临界值时预测价值最低。在校正了需要输血的因素后，只有最低的氧气输送仍然是一个独立的危险因素。体外循环期间高度血液稀释是术后肾功能障碍的危险因素；然而，通过适当增加泵的流量来增加氧气输送，可以减少其有害影响。
Background. The degree of hemodilution during cardiopulmonary bypass has recently been identified as an independent risk factor for acute renal failure after cardiac operations. In this prospective observational study we have investigated the role of the lowest oxygen delivery, lowest hematocrit, and pump flow during cardiopulmonary bypass as possible risk factors for acute renal failure and renal dysfunction.Methods. One thousand forty-eight consecutive patients undergoing coronary operations have been studied. For each patient we have recorded the lowest hematocrit on cardiopulmonary bypass, the correspondent lowest oxygen delivery, and the pump flow around the time of these determinations. The three variables have been explored in a multivariable model as possible risk factors for acute renal failure and postoperative serum creatinine levels increase. The role of transfusions in determining acute renal failure was subsequently included in the model.Results. The best predictor for acute renal failure and peak postoperative serum creatinine levels was the lowest oxygen delivery, with a critical value at 272 mL . min(-1). m(-2). The lowest hematocrit was an independent risk factor with a lowest predictive value at a cutoff of 26%. When corrected for the need for transfusions, only the lowest oxygen delivery remained an independent risk factor.Conclusions. A high degree of hemodilution during cardiopulmonary bypass is a risk factor for postoperative renal dysfunction; however, its detrimental effects may be reduced by increasing the oxygen delivery with an adequately increased pump flow.