文章摘要
术中肾动脉阻力指数用于预测心脏手术后急性肾损伤的效果
Effect of intraoperative renal artery resistance index in predicting postoperative acute kidney injury after cardiac surgery
  
DOI：10.12089/jca.2024.09.009
中文关键词: 肾动脉  阻力指数  急性肾损伤  心脏手术  预测  经食管超声心动图
英文关键词: Renal arterial  Resistance index  Acute kidney injury  Cardiac surgery  Prediction  Transesophageal echocardiography
基金项目:江苏省科技厅社会发展面上项目（BE2023749）；江苏省中医药科技发展计划项目（MS2022151）；扬州市科技局社会发展项目（YZ2022108）
作者单位E-mail
张转 225012，扬州大学附属医院麻醉科  
陈超 225012，扬州大学附属医院麻醉科  
张芯绮 新疆医科大学儿科学院  
袁博 225012，扬州大学附属医院麻醉科  
殷佳佳 225012，扬州大学附属医院麻醉科  
张荦 225012，扬州大学附属医院麻醉科  
张建友 225012，扬州大学附属医院麻醉科  
富智 225012，扬州大学附属医院麻醉科心脏大血管中心  
王强 225012，扬州大学附属医院麻醉科心脏大血管中心  
郁言龙 225012，扬州大学附属医院麻醉科 yuyanlong971222@163.com 
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中文摘要:
      
目的：探讨心肺转流(CPB)心脏手术中肾动脉阻力指数（RI）用于预测术后急性肾损伤（AKI）的效果。
方法：选择择期行CPB心脏手术患者44例，男21例，女23例，年龄≥18岁，BMI 18.5～30.0 kg/m2，ASA Ⅰ—Ⅲ级。于麻醉诱导后20 min（T1）、CPB结束后30 min（T2）经食管超声心动图（TEE）测量左肾动脉收缩期峰值流速（PSV）及舒张末期流速（EDV），计算出左肾动脉RI=（PSV-EDV）÷PSV。采用改善全球肾脏病预后组织(KDIGO)诊断标准判断AKI发生情况,根据术后是否发生AKI将患者分为两组：AKI组和非AKI组。采用多因素Logistic回归分析心脏手术后AKI的危险因素。
结果：共有16例（36%）发生AKI。与非AKI组比较，AKI组CPB时间及主动脉阻断时间明显延长（P<0.05），T1、T2时RI明显升高（P<0.05）。多因素Logistic回归分析显示，T2时RI是AKI发生的独立危险因素。T2时RI预测心脏术后AKI的AUC为0.893（95%CI 0.794～0.991，P<0.010），敏感性为84.5%，特异性为78.6%，截断值为0.720。
结论：术中肾动脉RI是CPB心脏手术后AKI的独立危险因素，CPB结束后30 min肾动脉RI>0.720可作为心脏手术后AKI的预测指标。
英文摘要:
      
Objective: To investigate the effect of intraoperative renal artery resistance index (RI) in predicting postoperative acute kidney injury (AKI) in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB).
Methods: Forty-four patients undergoing elective cardiac surgery with CPB, 21 males and 23 females, aged ≥ 18 years, BMI 18.5-30.0 kg/m2, ASA physical status Ⅰ-Ⅲ, were selected. Left renal artery peak systolic velocity (PSV) and end-diastolic velocity (EDV) were measured by transesophageal echocardiography (TEE) 20 minutes after general anesthesia induction (T1) and 30 minutes after CPB cessation (T2). RI was calculated as (PSV-EDV)/PSV. Patients were divided into two groups: the AKI group and the non-AKI group, according to whether occurred AKI by the diagnostic criteria of the kidney disease: improving global outcomes organization (KDIGO). Logistic multivariate regression analysis was performed to identify the risk factors for AKI occurrence.
Results: Sixteen patients (36%) occurred AKI. Compared with the non-AKI group, the CPB duration and aortic cross-clamp duration were significantly prolonged (P < 0.05), the renal artery RI at T1 and T2 were significantly increased in the AKI group (P < 0.05). Multivariate logstic analysis showed that RI at T2 was an independent risk factor for AKI occurrence after cardiac surgery, the AUC was 0.893 (95% CI 0.794-0.991, P < 0.010), the sensitivity and specificity were 84.5% and 78.6%, respectively, and the cut-off value was 0.720.
Conclusion: Intraoperative renal artery RI in patients undergoing cardiac surgery is an independent risk factor for AKI after cardiac surgery, and renal artery RI >0.720 at 30 minutes after CPB cessation can serve as a predictive indicator for AKI after cardiac surgery.
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