心脏手术后急性肾损伤的研究进展

Research Progress of Acute Kidney Injury after Cardiac Surgery

急性肾损伤(AKI)是心脏手术后常见且较为严重的并发症,其不仅延长患者的住院时间、增加医疗费用,还影响患者的长期存活率。AKI的发病机制受外源性或内源性毒素、缺血/再灌注、炎症和氧化应激等多种因素影响。同时,发生AKI的危险因素包括左心功能降低或心力衰竭、糖尿病、体外循环平均动脉压力等。而一些新生物学指标,如中性粒细胞明胶酶相关性脂质运载蛋白、肾损伤分子1、白细胞介素18、胱抑素C等可为早期识别AKI提供帮助。目前,AKI的治疗手段仍是强调预防而非治疗。未来,希望能通过制订AKI的早期诊断标准和采取积极的预防措施,减少AKI的发生,改善AKI患者预后。

Acute kidney injury(AKI)is a common and serious complication of cardiac surgery.It not only prolongs the hospitalization time,increases the medical cost,but also affects the long-term survival rate.The pathogenesis of AKI is influenced by many factors,such as exogenous or endogenous toxin,ischemia/reperfusion,inflammation and oxidative stress.At the same time,the risk factors for AKI include loss of left heart function or heart failure,diabetes,and the average arterial pressure in cardiopulmonary bypass.Some new biological indicators,such as neutrophil gelatinase-associated lipocalin,renal injury molecule 1,interleukin 18,cystatin C,can help early identify AKI.Currently,the treatment of AKI is still focused on prevention rather than treatment.In the future,we hope to improve the prognosis of patients with AKI by establishing the early diagnosis of AKI and taking positive preventive measures to reduce the incidence.