摘要
背景高达30%的心脏手术患者发生急性肾损伤(acute kidney injury,AKI),心脏手术后AKI的发生与患者短期和长期病死率独立相关。目的综述心脏手术后AKI的发病机制、预测和防治。内容心脏手术后AKI的发病机制包括多种途径,涉及血流动力学、炎症、代谢性和肾毒性因素。临床研究已经确定心脏手术相关急性肾损伤(cardiac surgery-associated acute kidney injury,CSA-AKI)的预测因子,可有效用于判断心脏手术患者发生AKI的风险。一些肾脏干预策略,例如减少高风险患者的有创操作、围手术期应用尿钠肽和非诺多泮、手术前液体预充、改善贫血以及手术后早期行肾脏替换治疗等已表现出一定的保护作用。趋向随着对CSA-AKI认识的增加,我们将能更好地对其实施预防和治疗。
Background Acute kidney injury (AKI) develops in up to 30% of patients undergoing cardiac surgery and the development of AKI after cardiac suigery is independently associated with substantial short- and long-term mortality. Objective This review will focus on pathogenesis, prediction, prevention and treatment of AKI after cardiac suigery. Content The pathogenesis of AKI involves multiple pathways, including hemodynamic, inflammatory, metabolic, nephrotoxic factors, etc. Clinical studies have identified predictors for cardiac surgery-associated acute kidney injury (CSA-AKI) that can be used effectively to determine the risk for AKI in patients undergoing cardiac surgery. Furthermore, several strategies, such as decreased invasive procedures in those at greatest risk, perioperative use of natriuretic peptide and fenoldopam, preoperative hydration, preoperative treatment of anemia, and postoperative early use of renal replacement therapy, have shown some renal protection. Trend As increasing knowledges of the pathogenesis of CSA-AKI, we will be able to carry out better preventive and therapeutic strategies.
出处
《国际麻醉学与复苏杂志》
CAS
2015年第12期1114-1118,1126,共6页
International Journal of Anesthesiology and Resuscitation
关键词
心脏手术
急性肾脏损伤
围手术期并发症
预测
治疗
Cardiac surgery
Acute kidney injury
Perioperative complications
Prediction
Therapy