吴西强, 刘建, 何思毅, 王舰, 殷小强, 刘敬臻, 吴松, 张近宝. 先天性心脏病相关肺动脉高压患儿术后急性肾损伤影响因素分析[J]. 心脏杂志, 2021, 33(3): 282-285. DOI: 10.12125/j.chj.202102067
    引用本文: 吴西强, 刘建, 何思毅, 王舰, 殷小强, 刘敬臻, 吴松, 张近宝. 先天性心脏病相关肺动脉高压患儿术后急性肾损伤影响因素分析[J]. 心脏杂志, 2021, 33(3): 282-285. DOI: 10.12125/j.chj.202102067
    shu
    Xi-qiang WU, Jian LIU, Si-yi HE, Jian WANG, Xiao-qiang YIN, Jing-zhen LIU, Song WU, Jin-bao ZHANG. Analysis of influencing factors of postoperative acute renal injury in children with congenital heart disease associated with pulmonary arterial hypertension[J]. Chinese Heart Journal, 2021, 33(3): 282-285. DOI: 10.12125/j.chj.202102067
    Citation: Xi-qiang WU, Jian LIU, Si-yi HE, Jian WANG, Xiao-qiang YIN, Jing-zhen LIU, Song WU, Jin-bao ZHANG. Analysis of influencing factors of postoperative acute renal injury in children with congenital heart disease associated with pulmonary arterial hypertension[J]. Chinese Heart Journal, 2021, 33(3): 282-285. DOI: 10.12125/j.chj.202102067
    shu

    先天性心脏病相关肺动脉高压患儿术后急性肾损伤影响因素分析

    Analysis of influencing factors of postoperative acute renal injury in children with congenital heart disease associated with pulmonary arterial hypertension

      摘要
    • 摘要:
        目的   探讨先天性心脏病相关肺动脉高压（congenital heart disease associated with pulmonary arterial hypertension, CHD-PAH）患儿在体外循环术后早期发生急性肾损伤（acute kidney injury, AKI）的影响因素。
        方法   2016年6月至2020年12月于我科在体外循环（cardiopulmonary bypass, CPB）下行心脏手术的3岁以下患儿，所有患儿均诊断为CHD-PAH，共纳入299例患儿，根据术后是否发生AKI分为AKI组（n=62）和非AKI组(n=237)，收集围术期资料进行统计学分析。
        结果   单因素Logistic回归分析结果显示包括年龄、身高、体质量、肺部感染、术前血清肌酐SCr值、术中CPB时间、主动脉阻闭时间（aortic occlusion time, ACT）、CHD 手术风险调整-1评分与术后AKI发生密切相关（P<0.05），多因素Logistic回归分析结果显示年龄、术前肺部感染、术前SCr值、ACT是AKI发生的独立危险因素（P<0.05）；AKI组患儿术后并发症包括二次插管、肾脏替代治疗和血液感染明显高于 非AKI组（P<0.05），术后机械通气时间、ICU停留时间、总住院时间明显延长和死亡率明显增高（P<0.05）。
        结论   低年龄、术前低SCr值、术前存在肺部感染和长ACT是术后AKI发生的独立危险因素，对高危人群制定积极预防措施，可能是减少术后AKI发生，改善临床预后的有效途径。

       

      Abstract:
        AIM  To investigate the influencing factors of early acute kidney injury(AKI)in children with congenital heart disease associated with pulmonary arterial hypertension(CHD-PAH)after cardiopulmonary bypass (CPB).
        METHODS   A retrospective study was conducted on children under 3 years old who underwent cardiac surgery under CPB in our department from June 2016 to December 2020. All patients with CHD-PAH, were divided into AKI group and non-AKI group according to the occurrence of AKI after operation. The perioperative data were collected and statistically analyzed.
        RESULTS   A total of 299 children were included in this study. The incidence of postoperative AKI, was 20.7% and the mortality rate was 4.8%. Univariate Logistic regression analysis showed that age,height, weight, pulmonary infection, preoperative creatinine,intraoperative CPB time, aortic occlusion time and risk adjustment for congenital heart surgery-1(RACHS-1) were closely related to postoperative AKI (P < 0.05). Multivariate Logistic regression analysis showed that age, preoperative pulmonary infection, preoperative creatinine value and aortic occlusion time were independent risk factors for AKI. The postoperative complications such as secondary intubation, renal replacement therapy and blood flow infection in the AKI group were significantly higher than those in the non-AKI group. The time of mechanical ventilation, the stay time of ICU and the total hospital stay were significantly prolonged and the mortality was significantly increased.
        CONCLUSION   Low age, low body weight, low preoperative creatinine value, preoperative pulmonary infection and long aortic occlusion time are independent risk factors for postoperative AKI. Active preventive measures for high-risk groups may be an effective way to reduce the incidence of postoperative AKI and improve clinical prognosis.

       

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