文章摘要
新生儿开胸心脏手术后急性肾功能损伤的危险因素
Risk factors of acute kidney injury in neonates undergoing congenital heart surgery
  
DOI：10.12089/jca.2020.12.014
中文关键词: 急性肾功能损伤  新生儿  先天性心脏病  危险因素
英文关键词: Acute kidney injury  Neonate  Congenital heart disease  Risk factor
基金项目:广东省自然科学基金（2018A030313535）；广东省医学科研基金（A2020038）；广东省基础与应用基础研究基金项目（2019A1515110063）
作者单位E-mail
温岚淇 510080,广州市,广东省人民医院（广东省医学科学院）麻醉科  
陈丽文 510080,广州市,广东省人民医院（广东省医学科学院）麻醉科  
鲁超 510080,广州市,广东省人民医院（广东省医学科学院）麻醉科  
王晟 510080,广州市,广东省人民医院（广东省医学科学院）麻醉科 shengwang_gz@163.com 
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中文摘要:
      
目的 分析新生儿开胸心脏手术后急性肾功能损伤（AKI）的危险因素。
方法 本研究为回顾性病例-对照研究。收集2017年3月至2018年6月在本院行开胸心脏手术的新生儿112例，男78例，女34例，手术日龄1～28 d，出生体重1.70～4.13 kg，手术日体重1.85～4.30 kg，ASA Ⅲ—Ⅴ级。本研究采用单因素分析和二元逐步Logistic回归分析术后AKI的危险因素。
结果 术后有42例（37.5%）患儿发生AKI。与非AKI患儿比较，术后合并AKI的患儿术后机械通气时间以及住院时间明显延长（P<0.05）。单因素分析结果显示：出生胎龄、术前乳酸浓度、术前NICU住院时间、更高的STAT手术难度分级、深低温停循环、术中最低温度、术后延迟关胸、术后非计划再次手术与AKI发生有关（P<0.05）。二元逐步Logistic回归分析显示，STAT手术难度4～5级（OR=5.805，95% CI 1.985～16.981，P=0.001）和深低温停循环（OR=4.475，95%CI 1.249～16.029，P=0.021）是新生儿开胸心脏术后发生AKI的独立危险因素。
结论 STAT手术难度4～5级和深低温停循环是开胸心脏手术患儿术后AKI的独立危险因素。
英文摘要:
      
Objective To analyze the risk factors of acute kidney injury (AKI) in neonates undergoing congenital heart surgery.
Methods From March 2017 to June 2018, medical records of 112 neonates undergoing congenital heart surgery were reviewed, 78 males and 34 females, ASA physical status Ⅲ—Ⅳ, the age at surgery was 1-28 days, the birth weight was 1.70-4.13 kg, and the operation weight was 1.85-4.30 kg. AKI was elicited by means of univariate and stepwise logistic regression analysis.
Results Forty-two (37.5%) neonates developed AKI after the cardiac surgery. Compared with normal neonates, postoperative mechanical ventilation time and hospitalization time of neonates with AKI were significantly prolonged (P < 0.05). The univariate analysis showed that birth age, preoperative lactic acid concentration, preoperative NICU length of stay, higher STAT risk category, deep hypothermic circulatory arrest, intraoperative minimum temperature, postoperative delayed sternal closure, and postoperative unplanned re-operation were associated with AKI (P < 0.05). Futher stepwise logistic regression showed that STAT risk category 4-5 (OR = 5.805, 95% CI 1.985-16.981, P = 0.001) and deep hypothermic circulatory arrest (OR=4.475, 95% CI 1.249-16.029, P = 0.021) were independent risk factors for AKI.
Conclusion STAT risk category 4-5 and deep hypothermia circulatory arrest are the independent risk factors for AKI after cardiac surgery.
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