尿氧分压监测对成人心脏手术相关急性肾损伤的早期预测价值

Early predictive value of urine oxygen partial pressure monitoring for acute kidney injury related to cardiac surgery in adults

目的探讨术中尿氧分压监测对行心肺转流下心脏手术患者发生急性肾损伤的预测价值。方法择期行心肺转流下心脏手术的患者46例,年龄在44岁-65岁。麻醉诱导后,监测并记录患者在整个手术期间的连续尿氧分压数值,计算患者的尿氧分压平均值,根据改善全球肾脏病预后组织提出的标准将患者分为急性肾损伤组和非急性肾损伤组。Logistic回归分析发生急性肾损伤的独立危险因素,受试者工作特征曲线评价尿氧分压平均值对急性肾损伤组发生的预测价值。结果与非急性肾损伤组相比,急性肾损伤组患者的尿氧分压平均值、年龄、高血压史、手术复杂程度、手术时间及术后CVP差异有统计学意义(P<0.05),其他指标两组差异无统计学意义(P>0.05)。二元Logistic回归分析显示:尿氧分压平均值和高血压病史是急性肾损伤的危险因素。ROC曲线分析显示:尿氧分压平均值的临界值为37.5 mmHg时,约登指数最大,敏感度和特异度分别为100%和28%,预测急性肾损伤的曲线下面积为0.827。结论尿氧分压平均值和高血压病史是急性肾损伤的独立危险因素,尿氧分压平均值<37.5 mmHg可以作为预测急性肾损伤发生的指标,为急性肾损伤的预防和诊断提供可行的解决方案。

Objective To exploring the predicted value of intraoperative urinary oxygen partial pressure(PuO_(2))monitoring for acute kidney injury(AKI)in patients undergoing cardiac surgery under cardiopulmonary bypass therapy.Methods 46 patients aged from 44 to 65 years old who underwent elective heart surgery under cardiopulmonary bypass therapy were selected into this study.After anesthesia induction,values of PuO_(2) of patients were monitored and recorded continuously throughout the entire surgical period,and average value of PuO_(2) of patients was calculated.All patient were divided into AKI group and non AKI group according to the standards proposed by improving kidney disease outcomes global organization(KDIGO).Logistic regression analysis was used to identify independent risk factors for the occurrence of AKI,and the receiver operating characteristic(ROC)curve was used to evaluate the predicted value of the average PuO_(2) value for the occurrence of AKI.Results Compared with the non acute kidney injury group,there was a statistically significant difference in oxygen partial pressure,age,history of hypertension,surgical complexity,surgical time,and postoperative CVP of patients in the acute kidney injury group(P<0.05),while there were no statistically significant differences in other indicators between the two groups(P>0.05).Binary logistic regression analysis showed that average PuO_(2) value and history of hypertension were risk factors for AKI.ROC curve analysis showed when the critical value of the average PuO_(2) value was 37.5mmHg,the Jordan index was the highest,with sensitivity and specificity of 100% and 28%,respectively.The area under curve(AUC)for predicting AKI was 0.827.Conclusion The average value of PuO_(2) and a history of hypertension are independent risk factors for AKI.The average value of PuO_(2)<37.5mmHg can be used as a predictive indicator for the occurrence of AKI,providing assistance for the prevention and diagnosis of AKI.