Study on kidney injury in cyanosis and acyanosis congenital heart disease after cardiopulmonary bypass operation: a single-center retrospective analysis / 中国小儿急救医学

ABSTRACT

Objective:To investigate the acute kidney injury(AKI) after cardiopulmonary bypass surgery for cyanotic congenital heart diseases(C-CHD) as well as and acyanotic congenital heart diseases(A-CHD)and its possible influencing factors.Methods:One hundred and three patients with CHD admitted to PICU of Xinhua Hospital Affiliated to Shanghai Jiaotong University were enrolled from July 1, 2017 to September 30, 2019.The patients were divided into C-CHD group( n=36)and A-CHD group( n=67). The preoperative general data and information related to the operation of two groups were recorded.Hemodynamic data, oxygen metabolism index, dose of vasoactive drugs during or after operation and liquid equilibrium were assessed after surgery.The incidence and stage of AKI were calculated.Multivariate Logistic regression was used to analyze the relationship between hemodynamic index and oxygen metabolism index and AKI.The predictive value of hemodynamics and oxygen metabolism for AKI after cardiac surgery was analyzed by receiver operating characteristic curve (ROC). Results:A total of one hundred and three patients were enrolled including sixty-two males and forty-one females, the median age was 7(4, 24) months old.The preoperative hemoglobin and hematocrit in the C-CHD group were higher than those in the A-CHD group( P<0.05). Compared with the A-CHD group, the C-CHD group had higher American Society of Anesthesiologists Grades and Risk Adjustment for Congenital Heart Surgery Grades, longer operation time and cardiopulmonary bypass time( P<0.05). Central venous pressure in C-CHD group was higher than that in A-CHD group, and C-CHD group had higher dose of vasoactive drugs after surgery( P<0.05). Compared with the C-CHD group, blood lactic acid was lower and arterial oxygen partial pressure was higher in the A-CHD group( P<0.05). Fifty patients developed AKI in the PICU, and the incidence of AKI in the A-CHD group was higher than that in the C-CHD, but there was no statistical significance(53.7% vs.38.9%, P>0.05). Multivariate Logistic regression analysis showed that partial arterial oxygen pressure and arterial oxygen satiety were independent risk factors for AKI( P<0.05). The large circulation index could not directly reflect the renal perfusion.Compared with using hemodynamic index or oxygen metabolism index alone to predict the occurrence of AKI 48 h after the operation, the combined application of the two methods had higher predictive value for AKI. Conclusion:Compared with patient with A-CHD, patients with C-CHD have higher tolerance to renal damage caused by surgery, and the kidney of patient with C-CHD have higher tolerance to postoperative fluid load and demand lower oxygen consumption.It is of great clinical significance to evaluate the changes of hemodynamics and oxygen metabolism after cardiac surgery for the prevention and treatment of renal injury.