心脏瓣膜置换术后患者平均动脉压水平对急性肾损伤发生的影响

Effect of mean arterial pressure on incidence of acute kidney injury in patients with heart valve replacement

目的：探讨体外循环心脏瓣膜置换术后提高平均动脉压（MAP）水平能否减少急性肾损伤（AKI）的发生率。方法选择行体外循环瓣膜置换术患者共259例，根据术后MAP控制水平分为五组：61～65 mmHg组、66～70 mmHg组、71～75 mmHg、76～80 mmHg、≥81 mmHg组，回顾性比较不同术后MAP组的术后6 h乳酸清除率、AKI发生率、住ICU时间、28 d死亡率。结果五组间术后6 h乳酸清除率及住ICU时间比较，差异均有统计学意义（F分别=-33.52、-46.36，P均＜0.05）。通过LSD法比较得出，MAP维持在71～75 mmHg较其他四组患者的术后6 h乳酸清除率高（t分别=1.21、2.04、1.05、1.70，P均＜0.05），住ICU时间短（t分别=1.85、1.56、1.07、1.13，P均＜0.05）；五组患者间术后AKI发生率及28 d死亡率比较，差异均无统计学意义（χ2分别=3.53，2.45，P均＞0.05）。结论心脏瓣膜置换术后提高MAP并不能减少AKI的发生；术后MAP维持在71～75 mmHg能明显提高患者术后6 h乳酸清除率，缩短ICU住院时间。

Objective To discuss whether increase the level of mean arterial pressure can reduce the incidence of acute kidney injury in patients with heart valve replacement. Methods A total of 259 cases who were undergoing heart valve re-placement surgery were divided into five groups according to the levels of mean arterial pressure： 61~65mmHg, 66~70mmHg, 71~75mmHg, 76~80mmHg and ≥81mmHg. The 6-hour lactate clearance rate, incidence of acute kidney in-jury, the length of ICU stay and 28 days mortality among groups were compared. Results The 6-hour lactate clearance rate and the length of ICU stay among five groups were statistically different （F=-33.52,-46.36,P〈0.05）. The highest 6-hour lactate clearance rate and the shortest length of ICU stay was seen in the group of 71~75mmHg when compared with other groups by LSD method（t=1.21, 2.04, 1.05, 1.70;1.85, 1.56, 1.07, 1.13,P〈0.05）.There was no significant differ-ence of AKI incidence and 28 days mortality among the groups （χ2=3.53,2.45,P〉0.05）. Conclusions Increasing the mean arterial pressure could not reduce the incidence of acute kidney injury in patients with heart valve replacement. The 6-hour lactate clearance rate and ICU length of stay can improved when the mean arterial pressure maintained at 71~75mmHg.