液体超负荷与婴儿先天性心脏病术后急性肾损伤的关系

Association between fluid overload and acute renal injury after congenital heart disease surgery in infants

目的探讨液体超负荷与婴儿先天性心脏病术后急性肾损伤(AKI)的关系。方法对88例年龄<6个月的行先天性心脏病根治术患儿进行回顾性研究。比较术后是否合并AKI患儿的治疗结局,以及术后第2天累积液体超负荷对治疗结局的影响,并分析术后AKI发生的影响因素。结果与术后无AKI患儿比较,合并AKI者年龄更小、体重更低,血肌酐、血管活性药物评分更高,术中体外循环时间和主动脉阻断时间更长,输血量更多、低心排综合征发生率更高,机械通气时间、ICU停留时间、住院时间更长,体外膜肺氧和使用率以及30 d死亡率更高,术后第2、3天的累积液体超负荷更高(P<0.05)。Logistic回归分析提示液体超负荷、低心排综合征是术后发生AKI的主要影响因素。术后第2天累积液体超负荷>5%的患儿低心排综合征发生率、机械通气时间、ICU停留时间和住院时间较长,死亡率较高(P<0.05)。结论先天性心脏病术后液体超负荷的婴儿易发生AKI,液体超负荷可能与术后不良结局有关。

Objective To study the association between fluid overload and acute kidney injury（AKI） after congenital heart disease surgery in infants. Methods A retrospective analysis was performed on 88 infants aged less than 6 months who underwent a radical surgery for congenital heart disease. The treatment outcomes were compared between the infants with AKI after surgery and those without. The effect of cumulative fluid overload on treatment outcomes 2 days after surgery was analyzed. The risk factors for the development of AKI after surgery were assessed by logistic regression analysis. Results Compared with those without AKI after surgery, the patients with AKI had younger age, lower body weights, higher serum creatinine levels and higher vasoactive-inotropic score, as well as longer durations of intraoperative extracorporeal circulation and aortic occlusion（P0.05）. Compared with those without AKI after surgery, the patients with AKI had a higher transfusion volume, a higher incidence rate of low cardiac output syndrome, a longer duration of mechanical ventilation, a longer length of stay in the intensive care unit（ICU）, a longer length of hospital stay, a higher application rate of extracorporeal membrane oxygenation, a higher 30-day mortality rate, and higher levels of cumulative fluid overload 2 and 3 days after surgery（P0.05）. The logistic regression analysis showed that fluid overload and low cardiac output syndrome were major risk factors for the development of AKI after surgery. The children with cumulative fluid overload 5% at 2 days after surgery had a higher incidence rate of low cardiac output syndrome, a longer duration of mechanical ventilation, a longer length of stay in the ICU, a longer length of hospital stay, and a higher mortality rate（P0.05）. Conclusions Infants with fluid overload after surgery for congenital heart disease tend to develop AKI, and fluid overload may be associated with poor outcomes after surgery.