Transfusion and risk of acute kidney injury in cardiac surgery
Transfusion and risk of acute kidney injury in cardiac surgery
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DOI：
10.1093/bja/aes422
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发表时间：
2012-12-01
影响因子：
9.8
通讯作者：
Karkouti, K.
中科院分区：
文献类型：
--
作者：
Karkouti, K.
急性肾损伤（阿基）是大手术的严重和常见并发症。本叙述性综述的重点是围手术期红细胞输注与体外循环（CPB）心脏手术后阿基之间的关系。许多观察性研究表明，这两个因素是相互独立的。几条证据表明，这种联系的性质是因果关系。输血可能损害肾脏的病理生理机制尚未完全阐明，但已知红细胞在储存期间发生不可逆的形态学和生化变化。因此，在输血后，它们可以促进促炎状态，损害组织氧气输送，并加剧组织氧化应激。这反过来又可能导致接受CPB心脏手术的易感患者发生阿基，例如预先存在肾功能不全或贫血的患者。因此，旨在避免围手术期输血的干预措施可能会降低心脏和其他类型手术后阿基的风险。
Acute kidney injury (AKI) is a serious and common complication of major surgery. This narrative review focuses on the relationship between perioperative red blood cell transfusion and AKI after cardiac surgery with cardiopulmonary bypass (CPB). Numerous observational studies have shown that these two factors are independently associated with each other. Several lines of evidence suggest that the nature of this association is one of cause and effect. The pathophysiological mechanism by which transfusions might harm the kidney has not been fully elucidated, but it is known that erythrocytes undergo irreversible morphological and biochemical changes during storage. As a result, after transfusion, they can promote a pro-inflammatory state, impair tissue oxygen delivery, and exacerbate tissue oxidative stress. This in turn can cause AKI in susceptible patients undergoing cardiac surgery with CPB, such as those with pre-existing kidney dysfunction or anaemia. Interventions aimed at avoiding perioperative blood transfusion might, therefore, reduce the risk of AKI after cardiac and other types of surgery.