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Objective To investigate the risk factors and prognosis influential factors of acute kidney injury (AKI) after cardiac surgery.Methods The clinical data of patients who were hospitalized and underwent cardiac surgery from April 2009 to May 2011 were collected prospectively.Demographic characteristics,types of surgeries,preoperative renal function,pre-and intra-operative conditions and clinical outcomes,etc were recorded.Results A total of 4007 patients underwent cardiac surgery were recruited.The overall incidence of AKI was 31.2％ (1250/4007).The incidence of AKI requiring renal replacement treatment (AKI-RRT) was 2.6％ (104/4007).The overall hospital mortality was 1.9％ (77/4007),and was significantly higher in AKI group than in non-AKI group (5.4％ vs 0.3％,P ＜0.01).The hospital mortality of AKI-RRT group was 36.5％ (38/104).Grouped by type of surgery,cardiac transplantation had the highest AKI incidence (73.0％) and highest in-hospital mortality (18.9％),followed by coronary artery bypass grafting (CABG) combined with valve surgery (AKI incidence 57.8％,in-hospital mortality 6.1％) and aneurysm surgery (AKI incidence 52.0％,in-hospital mortality 5.5％).Multivariate logistic regression analysis showed that man,age,BMI,hypertension,chronic heart failure,pre-operative serum creatinine (SCr) ＞ 106.0 μmol/L,intra-operative cardiopulmonary bypass time,intra-operative hypotension and aneurysm surgery were the risk factors of AKI after cardiac surgery.Multivariate logistic regression analysis showed that pre-operative SCr ＞ 106.0 μmol/L and intra-operative hypotension were independent risk factors of renal recovery after cardiac surgery while recovery of urine output was the favorable factor.Conclusions Cardiac surgery usually induces high AKI incidence and poor prognosis,which closely associated with many risk factors in peri-operative stage.The incidence of AKI is related to a number of perioperative risk factors.Heart transplantation,aneurysm surgery,CABG combined valve surgery are high risk surgeries.
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Objective To determine the proper dosage of fentanyl for open heart surgery performed under cardiopulmonary bypass (CPB) without aortic cross-clamping and cardioplegia.Methods Twenty-seven ASA Ⅰ -H patients (10 male, 17 female) with fairly good cardiac function (NYHA Ⅰ - Ⅱ) scheduled for surgical repair of atrioseptal defect ( ASD) or ventricular septal defect (VSD) or mitral valve replacement (MVR) were studied. Age ranged from 18 to 44 years and body weight from 35 to 58 kg. The patients were randomly divided into three fentanyl dosage groups: group Ⅰ 10?kg ; group II 30 ?g kg-1 and group Ⅲ 50 ?g kg-1. Premedication consisted of intramuscular pethidine 1-2 mg kg-1 and scopolamine 0.05-0.06 mg kg-1 . Anesthesia was induced with midazolam 0.2 mg kg-1 and fentanyl 5 ?g kg-1 . Tracheal intubation was facilitated with vecuronium 0.15 mg g-1 . The patients were mechanically ventilated (Vr 8-10 ml kg-1 ,F 10-12 bpm,FiO2 100% ). The rest of the total dose of fentanyl (5 ?g kg-1 in group I , 25 ?g kg-1 in group II , 45 ?g kg-1 in group III) was infused after induction of anesthesia until the initiation of CPB, supplemented with inhalation of 0.6 % isoflurane. During CPB propofol was infused at 5 mg kg-1 h-1 . after discontinuation of CPB, again 0.6% isoflurane was inhaled until the end of surgery. Vecuronium 0.05 mg kg was given every 25-30 min during operation. EGG, HR, BP, CVP, SpO2, PET CO2 and body temperature (naso-pharyngeal and rectal) were continuously monitored during operation. Arterial blood samples were obtained before anesthesia (T0), 5 min after tracheal intubation (T, ) , immediately after thoracotomy (T2) , immediately before CPB (T3), 15 min after CPB was initiated (T4) , 10 min after termination of CPB (T5) and 5 min after chest was closed (T6) for blood gas analyses and determination of blood electrolytes and acid-base balance and blood concentrations of glucose, ACTH, angiotensin Ⅱ (A- Ⅱ ) and cortisol. Time of emergence from anesthesia and extubation were recorded.Results The demographic data, including age and body weight, CPB time and duration of surgery were comparable among the three groups. There were no significant changes in SpO2 , PETCO2 , body temperature, blood gases and electrolytes during operation in the three groups. MAP decreased significantly during CPB. The blood glucose, ACTH, A- Ⅱ and cortisol concentrations increased significantly during and after CPB as compared with the preanesthetic baseline (T0 ) ( P