Effect of Shenfu Injection on acute kidney injury in children with congenital heart disease after operation / 中国中西医结合急救杂志

ABSTRACT

Objective To investigate the effect of Shenfu Injection on acute renal injury (AKI) in children with congenital heart disease after operation. Methods Sixty-two children with atrial or ventricular septal defect, treated in Affiliated Hospital of Southwest Medical University from August 2016 to December 2018, were divided into two groups according to different treatment methods, such as conventional Western medicine treatment group and Shenfu Injection group, with 31 cases in each group. The children in Shenfu Injection group were given 20 mL Shenfu Injection from the beginning of anesthesia induction to the end of cardiopulmonary bypass, the children in Western medicine conventional treatment group were pumped with the same volume of normal saline. The anesthesia time, total operation time, cardiopalmonary bypass time, aortic clamping time, and the use of milrinone, dopamine, epinephrine, sodium nitroprusside and other drugs in the two groups were observed. The serum creatinine (SCr) level was measured by chemiluminescence method before operation (T0), at the beginning of operation (T1), at the beginning of cardiopulmonary bypass (T2), at the end of cardiopulmonary bypass (T3) and at the end of operation (T4), and the glomerular filtration rate (eGFR) was calculated. The mean arterial pressure (MAP), heart rate (HR), central venous pressure (CVP), adrenaline (E) and noradrenaline (NE) in two groups were recorded at each time point. Results There was no significant difference in anesthesia time, total operation time, cardiopalmonary bypass time, aortic clamping time and the use of milrinone, dopamine, E and sodium nitroprusside between the Shenfu Injection group and Western medicine conventional treatment group (all P > 0.05). There was no significant difference in HR and CVP between the two groups at T0-T4 (all P > 0.05). There was no significant difference in MAP level between the two groups at T0 and T1( both P > 0.05), with the time prolonging, the MAP level of Western medicine conventional treatment group was significantly lower than that of T0, while MAP level of Shenfu Injection group was significantly higher than that of T0. At T2, the MAP level of Shenfu Injection group was significantly higher than that of the Western medicine conventional treatment group [mmHg (1 mmHg = 0.133 kPa) 66.6±6.5 vs. 53.1±6.7, P < 0.05]. There was no significant difference in E and NE between the two groups at T0 and T1 (P > 0.05), with the time prolonging, both E and NE decreased compared with those at T0 (both P < 0.05), but there was no significant difference at the same time point (all P > 0.05). At T0, there was no significant difference in SCr and eGFRs between the two groups (both P > 0.05), at T1, the SCr levels of two groups were significantly higher than those at T0, but the SCr level of Shenfu Injection group was significantly lower than that of Western medicine conventional treatment group (μmol/L 42.43±15.91 vs. 56.58±16.80, all P < 0.05). From T2, the SCr levels of two groups began to gradually reduce, but it was still significantly higher than those at T0, the two groups reached the lowest level at T4, and the level of SCr in Shenfu Injection group was significantly lower than that of Western medicine conventional treatment group (μmol/L 36.24±9.72 vs. 46.85±15.91, P < 0.05). Compared with T0, the eGFRs levels of the two groups were significantly lower at T1-T4, but gradually increased with time, reached the highest level at T4, and the eGFRs level of Shenfu Injection group was significantly higher than that of Western medicine conventional treatment group (mL·min-1·1.73 m-2 113.7±12.1 vs. 79.6±12.5, P < 0.05). The incidence of AKI in Shenfu Injection group was significantly lower than that in Western medicine conventional treatment group [22.58% (7/31) vs. 64.52% (20/31), P < 0.05]. Conclusion Shenfu Injection can reduce the incidence of AKI in children with congenital heart disease after operation.