肾区域组织氧饱和度预测紫绀型患儿心脏手术后急性肾损伤的效果

Predictive effect of renal regional tissue oxygen saturation on acute kidney injury in children with cyanotic infants after cardiac surgery

目的探讨紫绀型先天性心脏病患儿心脏手术围术期肾区域组织氧饱和度(RrSO2)对术后急性肾损伤(AKI)的预测价值。方法选取心肺转流(CPB)下接受心脏手术的紫绀型先天性心脏病患儿36例,男22例,女14例,年龄≤1岁,分别于气管插管后5 min(T1)、升主动脉夹闭后5 min(T2)、升主动脉开放后5 min(T3)、CPB结束(T4)、超滤结束(T5)、CPB结束后3 h(T6)、CPB结束后8 h(T7)、CPB结束后24 h(T8)记录MAP、RrSO2、鼻咽温,同时抽取动脉血和中心静脉血进行血气分析,记录动脉血氧饱和度(SaO2)、动脉血Hb、乳酸(Lac)、中心静脉血氧饱和度(ScvO2),根据改善全球肾脏病预后组织(KDIGO)诊断标准将患儿分为两组:急性肾损伤组(D组)和正常组(N组)。单因素分析两组患儿的临床资料,将不同时点MAP、RrSO2、鼻咽温、Hb、SaO2、Lac、ScvO2值、有意义变量纳入二元Logistic回归分析,采用受试者工作特征(ROC)曲线分析RrSO2对AKI的预测价值。结果 T3-T6时D组RrSO2明显低于N组(P<0.01)。两组不同时点MAP、鼻咽温、SaO2、Hb、Lac和ScvO2差异无统计学意义。二元Logistic回归分析显示,T3-T6时RrSO2是紫绀型先天性心脏病患儿心脏术后AKI的危险因素(P<0.05)。ROC曲线分析结果显示,T3-T6时RrSO2临界值分别为60.2%、57.2%、55.0%、54.0%,敏感性分别为66.7%、83.3%、66.7%、83.3%,特异性分别为100%、92%、100%、75%,曲线下面积分别为0.896、0.861、0.792、0.840。结论 RrSO2可作为紫绀型先天性心脏病患儿心脏AKI的一项无创预测指标。

Objective To investigate the predictive value of renal regional tissue oxygen saturation(RrSO2)on postoperative acute kidney injury(AKI)in children with cyanotic infant heart surgery.Methods Eliglibility criteria included thirty-six infants with 0-1 year-old(22 males and 14 females)cyanotic congenital heart disease underwent cardiac surgery under cardiopulmonary bypass(CPB).Mean arterial pressure(MAP),RrSO2,nasopharyngeal temperaturemeasurements were summarized at eight time points:5 minutes after tracheal intubation(T1),5 minutes after ascending aortic clamping(T2),5 minutes after ascending aorta unclamping(T3),end of CPB(T4),end of ultrafiltration(T5),3 hours after CPB(T6),8 hours after CPB(T7),24 hours after CPB(T8).Arterial blood and central venous blood were taken at the same time,blood gas analysis was performed to record arterial oxygen saturation(SaO2),arterial blood lactate(Lac),arterial hemoglobin concentration(Hb),center venous oxygen saturation(ScvO2).The children were divided into acute kidney injury group(group D)and normal group(group N)according to the diagnostic criteria of Kidney Disease:Improving Global Outcomes(KDIGO).Univariate analysis of clinical data of two groups of children,MAP,RrSO2,nasopharyngeal temperature,Hb,SaO2,Lac,ScvO2 values,significant variables at different time points were included in binary logistic regression analysis,using receiver operating characteristics(ROC)curve analysis of the predicted value of RrSO2 for AKI.Results The RrSO2 at T3-T6 in group D were significantly lower than those in group N(P<0.01).There was no significant difference in MAP,nasopharyngeal temperature,SaO2,Hb,Lac and ScvO2 in different time points.Binary logistic analysis showed that RrSO2 at T3-T6 were the risk factors of AKI in infants with cyanotic congenital heart disease(P<0.05).ROC curve analysis showed that when RrSO2 was 60.2%,57.2%,55%and 54%at T3-T6 respectively.The sensitivity was 66.7%,83.3%,66.7%and 83.3%respectively,and the specificities were 100%,91.7%,100%and 75%,respectively,the area under the AUC curve was 0.896,0.861,0.792 and 0.840,respectively.Conclusion RrSO2 can be used as a non-invasive predictor of AKI in infants with cyanotic congenital heart disease.