先天性心脏病患儿体外循环下心脏术后发生急性肾损伤的影响因素及预后分析

Influencing Factors and Prognosis of Acute Kidney Injury after Cardiopulmonary Bypass in Children with Congenital Heart Disease

目的探讨先天性心脏病(congenital heart disease, CHD)患儿体外循环(cardiopulmonary bypass, CPB)下心脏术后发生急性肾损伤(acute kidney injury, AKI)的影响因素及预后危险因素。方法回顾性分析2013年10月-2017年10月我院诊治的行CPB下心脏手术的CHD患儿560例,依据术后48 h是否发生AKI分为AKI组100例和非AKI组460例。分析2组一般资料,采用多因素Logistic回归分析寻找AKI发生的危险因素;对AKI组患儿进行随访,采用Cox回归分析术后发生AKI患儿的预后危险因素。结果多因素Logistic回归分析发现,年龄<12个月、有肺炎或心力衰竭史、术前血肌酐>70μmol/L、主动脉阻断时间>30 min、CPB时间>45 min是CHD患儿CPB下心脏术后AKI发生的危险因素(P<0.05或P<0.01);截止末次随访,100例AKI组患儿存活82例,死亡18例,病死率为18.0%,Cox回归分析显示术后美国纽约心脏病学会心功能分级Ⅲ~Ⅳ级、术中血糖>8.3 mmol/L是CHD CPB下心脏术后发生AKI患儿的预后危险因素(P<0.05或P<0.01)。结论年龄(<12个月)、有肺炎或心力衰竭史、术前血肌酐升高(>70μmol/L)、主动脉阻断时间延长(>30 min)、CPB时间延长(>45 min)可增加CHD患儿CPB下心脏术后发生AKI的风险,术中血糖的严格控制有助于改善术后AKI患儿的生存状态。

Objective To investigate the influencing factors and prognostic risk factors of acute kidney injury(AKI) after cardiac surgery under cardiopulmonary bypass(CPB) in children with congenital heart disease(CHD). Methods A retrospective analysis was performed on clinical data of 560 children with CHD that underwent cardiac surgery under CPB in our hospital from October 2013 to October 2017. They were divided into AKI group(n=100) and non-AKI group(n=460) according to presence or absence of AKI at 48 h after CPB. The general data of the two groups was analyzed, and multivariate logistic regression analysis was performed to explore the risk factors of AKI. The children in the AKI group were followed up for 2 years. Cox regression was used to analyze the prognostic risk factors of children with AKI after CPB. Results Multivariate logistic regression analysis found that age <12 months, history of pneumonia or heart failure, preoperative blood creatinine >70 μmol/L, duration of aortic occlusion >30 min, duration of CPB >45 min were risk factors for AKI in children with CHD after CPB(P<0.05 or P<0.01). At the last follow-up, 82 out of 100 children in AKI group survived and 18 died, with a mortality of 18.0%. Cox regression analysis showed that postoperative NYHA cardiac function grades Ⅲ to Ⅳ, and intraoperative blood glucose > 8.3 mmol/L were prognostic risk factors for AKI in children with CHD after CPB(P<0.05 or P<0.01). Conclusion Age(<12 months), history of pneumonia or heart failure, preoperative serum creatinine(>70 μmol/L), prolonged aortic occlusion(>30 min), prolonged CPB(>45 min) could increase the risk of AKI after CPB in children with CHD. Strict control of intraoperative blood glucose helps improve the survival of children with AKI after surgery.