Nadir Oxygen Delivery on Bypass and Hypotension Increase Acute Kidney Injury Risk After Cardiac Operations
Nadir Oxygen Delivery on Bypass and Hypotension Increase Acute Kidney Injury Risk After Cardiac Operations
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DOI：
10.1016/j.athoracsur.2015.05.059
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发表时间：
2015-11-01
影响因子：
4.6
通讯作者：
Whitman, Glenn J.
中科院分区：
文献类型：
--
作者：
Magruder, J. Trent;Dungan, Samuel P.;Whitman, Glenn J.
背景。急性肾损伤（AKI）继续使心脏手术复杂化。我们试图确定体外循环（CPB）的最低点供氧（DO2）是否是AKI的危险因素，同时也考虑了其他术后因素。使用倾向评分法，我们将85例在CPB心脏手术后发生AKI的患者与85例未发生AKI的对照组患者进行匹配。我们分析了术后第1天午夜（POD1）的以下变量：DO2、抗生素、血液制品和血管加压药物（术中和术后）以及血流动力学变量。单变量分析显示AKI患者CPB最低点DO2较低（208 vs 230 mL O-2/min/m(2)体表面积，p = 0.03），重症监护病房入院时跨肾血压梯度较低(平均动脉压-中心静脉压，60 vs 68 mm Hg；p < 0.001)，术后15分钟内平均动脉压小于60毫米汞柱的患者比例更高（70% vs 42%, p < 0.001），心脏指数小于2.2的可能性更高（74% vs 49%, p = 0.02），并且在POD1结束时总血管加压剂的使用更高（5.2 vs 2.3 mg, p = 0.002）。在多变量分析中，AKI的预测因子为CPB DO2小于225 mL O-2/min/m(2)（优势比2.46；95%可信区间1.21 ~ 5.03;p = 0.01）和术后平均动脉压小于60 mm Hg超过15分钟（优势比3.96；95%可信区间1.92 ~ 8.20;p < 0.001）。术后平均加压剂量大于0.03 mg/kg/min没有达到显著性（优势比为1.98；95%可信区间为0.95 ~ 4.11;p = 0.07）。术后POD0或POD1低血压和CPB低DO2均独立增加心脏手术患者AKI的风险。(C) 2015年由胸外科学会发布
Background. Acute kidney injury (AKI) continues to complicate cardiac operations. We sought to determine whether nadir oxygen delivery (DO2) on cardiopulmonary bypass (CPB) was a risk factor for AKI while also accounting for other postoperative factors.Methods. Using propensity scoring, we matched 85 patients who developed AKI after cardiac operations on CPB with 85 control patients who did not. We analyzed the following variables through midnight on postoperative day 1 (POD1): DO2, antibiotics, blood products and vasopressors (intraoperatively and postoperatively), and hemodynamic variables.Results. Univariable analysis revealed AKI patients had lower nadir DO2 on CPB (208 vs 230 mL O-2/min/m(2) body surface area, p = 0.03), lower intensive care unit admission blood pressure gradient across the kidney (mean arterial pressure minus central venous pressure; 60 vs 68 mm Hg; p < 0.001), a greater proportion of patients with mean arterial pressure of less than 60 mm Hg for more than 15 minutes in the postoperative period (70% vs 42%, p < 0.001), a greater chance of having a cardiac index of less than 2.2 (74% vs 49%, p = 0.02), and greater total vasopressor use through the end of POD1 (5.2 vs 2.3 mg, p = 0.002). On multivariable analysis, predictors of AKI were a DO2 on CPB of less than 225 mL O-2/min/m(2) (odds ratio, 2.46; 95% confidence interval, 1.21 to 5.03; p = 0.01) and postoperative mean arterial pressure of less than 60 mm Hg for more than 15 minutes (odds ratio, 3.96; 95% confidence interval, 1.92 to 8.20; p < 0.001). An average postoperative pressor dose greater than 0.03 mg/kg/min did not reach significance (odds ratio, 1.98; 95% confidence interval, 0.95 to 4.11; p = 0.07).Conclusions. Postoperative hypotension on POD0 or POD1 and low DO2 on CPB both independently increase the AKI risk in cardiac surgical patients. (C) 2015 by The Society of Thoracic Surgeons