肠和肾血氧饱和度能较好预测小儿先天性心脏病术后急性肾损伤

Prediction value of regional oxygen saturation in intestine and kidney for acute kidney injury in children with congenital heart disease after surgery

目的:研究脑、肠、肾区域血氧饱和度(rSO_(2))预测小儿先天性心脏病术后急性肾损伤(AKI)发生的价值。方法:选择2020年1—12月在上海交通大学医学院附属上海儿童医学中心进行体外循环先天性心脏病纠治术、体重大于2.5 kg且年龄在1岁及以下的患儿57例。采用近红外光谱连续监测患儿术后48 h内脑、肠、肾rSO_(2)。比较AKI组与非AKI组,以及发生与未发生2级及以上AKI患儿脑、肠、肾rSO_(2)的变化差异,并采用ROC曲线分析肠、肾rSO_(2)对术后发生AKI及严重程度的预测价值。结果:57例患儿中,38例(66.7%)发生AKI,其中AKI 1级18例(47.4%),AKI 2级9例(23.7%),AKI 3级11例(28.9%),AKI总发生率约为66.7%。AKI组与非AKI组脑rSO_(2)的变化差异无统计学意义(F=0.012,P>0.05),但AKI组肠rSO_(2)和肾rSO_(2)明显低于非AKI组(F=5.017和5.003,均P<0.05)。发生与未发生2级及以上AKI患儿脑rSO_(2)的变化差异无统计学意义(F=0.311,P>0.05),但发生2级及以上AKI患儿肠rSO_(2)和肾rSO_(2)均低于未发生2级及以上AKI患儿(F=6.431和14.139,均P<0.05)。对术后AKI的预测效能进行分析发现,24 h内肠rSO_(2)的诊断效能较好,其中术后3 h肠rSO_(2)诊断AKI的曲线下面积(AUC)为0.823,以术后3 h肠rSO_(2)低于85%预测AKI的敏感度为66.7%、特异度为89.5%;24~48 h肾rSO_(2)的诊断效能较好,其中术后31 h肾rSO_(2)诊断AKI的AUC为0.918,以术后31 h肾rSO_(2)低于84%预测AKI的敏感度为72.2%、特异度为84.2%。对术后发生2级及以上AKI的预测效能进行分析发现,24 h内肠rSO_(2)的诊断效能较好,其中术后3 h肠rSO_(2)诊断2级及以上AKI的AUC为0.829,以术后3 h肠rSO_(2)低于84%预测2级及以上AKI的敏感度为62.2%、特异度为90.0%;24~48 h肾rSO_(2)的诊断效能较好,其中术后34 h肾rSO_(2)诊断2级及以上AKI的AUC为0.826,以术后34 h肾rSO_(2)低于71%预测2级及以上AKI的敏感度为91.9%、特异度为55.0%。结论:肠、肾rSO_(2)不仅对术后AKI发生有较好的预测作用,同时对AKI的严重程度也有较好的预测效能。

Objective:To study the prediction value of regional oxygen saturation(rSO_(2))in brain,intestine and kidney for acute kidney injury(AKI)in children with congenital heart disease after surgery.Methods:Fifty-seven children with congenital heart disease(CHD),whose weight>2.5 kg and age≤1 year were treated in Shanghai Children’s Medical Center,Shanghai Jiao Tong University School of Medicine from January 2020 to December 2020.The rSO_(2) of brain,intestine and kidney were monitored with near-infrared spectroscopy continuously for 48 h after surgery.The predictive values of cerebral,intestinal and renal rSO_(2) for occurrence and severity of postoperative AKI were analyzed.Results:Among 57 patients,postoperative AKI developed in 38 cases(66.7%),including 18 cases of AKI-1(47.4%),9 cases of AKI-2(23.7%)and 11 cases of AKI-3(28.9%).There was no significant difference in cerebral rSO_(2) between AKI group and non-AKI group(F=0.012,P>0.05),while the intestinal rSO_(2) and renal rSO_(2) in AKI group were significantly lower than those in non-AKI group(F=5.017 and 5.003,both P<0.05).There was no significant difference in brain rSO_(2) between children with or without AKI-2 and above(F=0.311,P>0.05),but the intestinal rSO_(2) and renal rSO_(2) in children with AKI-2 and above were lower than other children(F=6.431 and 14.139,both P<0.05).The area under ROC curve(AUC)of intestinal rSO_(2)3 h after surgery for predicting AKI was 0.823,and with intestinal rSO_(2)3 h after surgery<85%,the sensitivity and specificity were 66.7% and 89.5%,respectively.The AUC of renal rSO_(2) for the diagnosis of AKI at 31 h after surgery was 0.918,and with intestinal rSO_(2)31 h after surgery<84%,the sensitivity and specificity were 72.2% and 84.2%,respectively.The AUC of intestinal rSO_(2)3 h after surgery for the diagnosis of AKI-2 and above was 0.829,and with intestinal rSO_(2)3 h after surgery<84%,the sensitivity and specificity were 62.2% and 90.0%,respectively.The AUC of renal rSO_(2) for the diagnosis of AKI-2 and above was 0.826 at 34 h postoperatively,and with intestinal rSO_(2)34 h after surgery<71%,the sensitivity and specificity were 91.9%and 55.0%,respectively.Conclusion:The monitoring of intestinal and renal rSO_(2) can predict the occurrence and severity of postoperative AKI in children with congenital heart disease after surgery.