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目的探讨婴幼儿先天性心脏病(CHD)体外循环(CPB)术后急性肾损伤(AKI)的临床危险因素。方法选择2010年1-12月在北京安贞医院小儿心脏科住院的、年龄≤3岁的58例CHD患儿,患儿均行CPB手术。1.根据CPB时间分为3组:CPB<90 min 15例,90～149 min 25例,≥150 min 18例。2.根据CHD外科危险分层(RACHS-1)分为3组:2级26例,3级22例,4级10例。3.根据年龄分为2组:低龄组,年龄≤6个月27例;大龄组,年龄>6个月～3岁31例。AKI定义为术后48 h内血清Cr升高≥26.4μmol.L-1或较原水平增长≥50%和(或)尿量减少至<0.5 mL.kg-1.h-1达6 h(除外梗阻性肾病或脱水状态)。比较术后各组发生AKI的比例。结果 1.CPB 90～149 min组和≥150 min组术后发生AKI的比例显著高于CPB<90 min组(52.0%vs13.3%,P<0.05;77.8%vs 13.3%,P<0.001),CPB≥150 min组发生AKI的比例虽高于90～149 min组,但差异无统计学意义(P>0.05)。2.术后发生AKI的比例,RACHS-1 4级组(90.0%)及3级组(59.1%)显著高于2级组(26.9%)(4级vs 2级,P<0.01;3级vs 2级,P<0.05);4级组虽高于3级组,但差异无统计学意义(P>0.05)。3.低龄组AKI的比例高于大龄组(63.0%vs38.7%),但其差异无统计学意义(P>0.05)。结论年龄、RACHS-1分级和CPB持续时间均与CHD患儿CPB术后AKI相关,CPB时间越长、RACHS-1分级越高、年龄越小,AKI发生率越高。
Objective To investigate the clinical risk factors of acute kidney injury (AKI) after infantile congenital heart disease (CHD) cardiopulmonary bypass (CPB). Methods Fifty-eight CHD children aged ≤3 years who were hospitalized in Pediatric Cardiology Department of Anzhen Hospital, Beijing from January to December 2010 were enrolled. All children underwent CPB. According to CPB time is divided into 3 groups: CPB <90 min 15 cases, 90 ~ 149 min 25 cases, ≥ 150 min 18 cases. According to the CHD surgical risk stratification (RACHS-1) is divided into 3 groups: 26 cases of grade 2, 22 cases of grade 3, 10 cases of grade 4. According to the age divided into two groups: the younger age group, age ≤ 6 months in 27 cases; older group, age> 6 months to 3 years old in 31 cases. AKI was defined as an increase in serum Cr ≥26.4 μmol.L-1 or ≥50% and / or urine output to <0.5 mL.kg-1.h-1 for up to 6 h Except for obstructive nephropathy or dehydration). The proportion of AKI in each group was compared. Results 1. The incidence of AKI in 90-149 min and ≥ 150 min groups was significantly higher than that in CPB <90 min group (52.0% vs 13.3%, P <0.05; 77.8% vs 13.3%, P <0.001) The incidence of AKI in CPB≥150 min group was higher than that in 90 ~ 149 min group, but the difference was not statistically significant (P> 0.05). The incidence of AKI after operation was significantly higher in RACHS-1 grade 4 (90.0%) and grade 3 (59.1%) than in grade 2 (26.9%) (Grade 4 vs Grade 2, P <0.01; Grade 3 vs level 2, P <0.05). Although the level 4 group was higher than the level 3 group, the difference was not statistically significant (P> 0.05). The proportion of AKI in younger age group was higher than that in older age group (63.0% vs38.7%), but the difference was not statistically significant (P> 0.05). Conclusions Age, RACHS-1 grade and duration of CPB are all associated with AKI after CPB in children with CHD. The longer the CPB time, the higher the RACHS-1 grade, the younger the age and the higher the incidence of AKI.