肾氧饱和度在DeBakeyⅠ型主动脉夹层术后急性肾损伤中的预测价值

Predictive value of intra-operative renal regional oxygen saturation in acute kidney injury after DeBakey typeⅠaortic dissection surgery

目的研究肾氧饱和度(RrSO2)在主动脉夹层手术后急性肾损伤(AKI)中的预测价值。方法2019年1月至2023年1月在我院行外科手术治疗的DeBakeyⅠ型主动脉夹层患者120例。术中将近红外光谱仪(苏州爱琴生物医疗电子有限公司,BGOS-600B)探头分别固定于双侧肾脏体表定位区,持续记录手术过程中的RrSO2。应用SPSS 23.0统计软件分析,观察术中RrSO2水平与术后AKI发生风险之间的相关性。结果120例患者术后发生AKI 13例,比较AKI组和非AKI组患者一般资料:男性为9(69.23%)比78(72.90%),P>0.05;年龄为(56.73±11.74)岁比(54.94±12.52)岁,P>0.05;体重为(68.57±16.09)kg比(67.16±19.27)kg,P>0.05;高血压病史为10(76.92%)比77(71.86%),P>0.05;糖尿病病史为6(46.15%)比49(45.79%),P>0.05;肌酐为(78.91±19.54)μmol/L比(77.25±21.36)μmol/L,P>0.05;体外循环时间为(178.2±44.7)min比(166.7±49.4)min,P>0.05;主动脉阻断时间为(85.7±29.4)min比(79.9±31.5)min,P>0.05;停循环时间为(31.4±11.3)min比(33.9±10.5)min,P>0.05;差异均无统计学意义。采用卡方检验比较AKI组和非AKI组患者RrSO2(%)(左右肾平均值)在低于基线<25%且持续时间<60 min组分布:0(0.00%)比25(23.36%),P>0.05;在低于基线25%~50%且持续时间<60 min组分布:1(7.69)比30(28.04),P>0.05;在低于基线>50%且持续时间<60 min组分布:2(15.38)比3(2.80),P<0.05;在低于基线<25%且持续时间>60 min组分布:1(7.69)比36(33.64),P>0.05;在低于基线25%~50%且持续时间>60 min组分布:3(23.08)比7(6.54),P<0.05;在低于基线>50%且持续时间>60 min组分布:6(46.15)比6(5.61),P<0.05。显示在低于基线>50%且持续时间<60 min、低于基线25%~50%且持续时间>60 min、低于基线>50%且持续时间>60 min的3组间AKI发生率显著升高。结论术中RrSO2对DeBakey I型主动脉夹层患者术后发生急性肾损伤的有一定预测价值。

Objective To investigate the predictive value of intra-operative renal regional oxygenation saturation(RrSO2)in acute kidney injury(AKI)after aortic dissection.Methods A total of 120 patients with DeBakey typeⅠaortic dissection undergoing surgical treatment in our hospital during January 2019 to January 2023 were included.Near infrared spectrometer probes were placed at the left and right kidney body surface positioning area to monior RrSO2 continuously during the operation.SPSS 23.0 statistical software was used to explore the correlation between different RrSO2 groups and AKI risk.Results There were 13 cases of postoperative AKI among the 120 patients,and the comparison of the general data between the AKI group and the non-AKI group showed that there was no statistical significance in the proportion of males[9(69.23%)vs.78(72.90%),P>0.05].There was no significant difference in age[(56.73±11.74)years vs.(54.94±12.52)years,P>0.05].There was no significant difference in body weight[(68.57±16.09)kg vs.(67.16±19.27)kg,P>0.05].There was no significant difference in the proportion of hypertension[10(76.92%)vs.77(71.86%),P>0.05].There was no significant difference in the proportion of diabetes mellitus[6(46.15%)vs.49(45.79%),P>0.05].There was no significant difference in creatinine[78.91±19.54μmol/L vs.77.25±21.36μmol/L,P>0.05].There was no significant difference in CPB duration[(178.2±44.7)min vs.(166.7±49.4)min,P>0.05].There was no significant difference in the duration of aorta occlusion[(85.7±29.4)min vs.(79.9±31.5)min,P>0.05].There was no significant difference in stopping cycle time[(31.4±11.3)min vs.(33.9±10.5)min,P>0.05].Chi-square test was used to compare RrSO2(%)(mean kidney value)between AKI and non-AKI patients:there was no statistically significant difference in the distribution at<25%below baseline and duration<60 min[0(0.00%)vs.25(23.36%),P>0.05].There was no significant difference in the distribution between 25%-50%lower than baseline and the duration<60 min[1(7.69)vs.30(28.04),P>0.05].>50%below baseline and duration<60 min were statistically significant[2(15.38)vs.3(2.80),P<0.05].There was no significant difference in the distribution of<25%below baseline and duration>60 min[1(7.69)vs.36(33.64),P>0.05].There was statistical difference in the distribution of 25%-50%lower than baseline and the duration>60 min[3(23.08)vs.7(6.54),P<0.05].In the group>50%below baseline and>60 min in duration,the difference in distribution was statistically significant[6(46.15)vs.6(5.61),P<0.05].The incidence of AKI increased significantly among groups>50%below baseline with duration<60 min,25%-50%below baseline with duration>60 min,and>50%below baseline with duration>60 min.Conclusion Intra-operative RrSO2 has a certain predictive value in predicting the risk of postoperative AKI in patients with DeBakey typeⅠaortic dissection.