發(fā)布時間：2018-04-03 05:16

  本文選題：輸血　切入點：急性腎損傷　出處：《浙江大學(xué)》2014年博士論文

【摘要】：研究背景：小兒先天性心臟病(先心病)體外循環(huán)術(shù)后有發(fā)生急性腎損傷的風(fēng)險。近年來輸血相關(guān)的不良后果仍在不斷被發(fā)現(xiàn),小兒先心病患者中輸血相關(guān)急性腎損傷的研究很缺乏。本研究旨在描述小兒先心病體外循環(huán)術(shù)后輸血與腎損傷的相關(guān)性。 研究方法：回顧性分析2010年1-9月我院487例患有先心病并行體外循環(huán)下手術(shù)的患兒。使用亞里士多德評分對患兒手術(shù)的復(fù)雜程度進(jìn)行分層。根據(jù)RIFLE標(biāo)準(zhǔn),急性腎損傷定義為血清肌酐值較術(shù)前值增加50%或以上。 結(jié)果：研究隊列中男265例(54.4%),女222例(45.6%),中位年齡19個月。術(shù)后3天內(nèi)有68例(14%)的患兒發(fā)生了急性腎損傷。手術(shù)復(fù)雜(亞里士多德評分為Level3和Level4)的患兒腎損傷發(fā)生率與手術(shù)簡單(亞里士多德評分為Level1和Level2)的患兒相比沒有統(tǒng)計學(xué)差異(21.0%vs12.9%, OR=1.78,95%CI0.91-3.50,P=0.088)；體外循環(huán)時間60min的患兒腎損傷發(fā)生率低(OR=0.28,95%CI0.16-0.49,P0.001)。大量輸血伴隨著腎損傷發(fā)生率的急劇上升,輸血最大輸注量組(90ml·kg-1)和最小輸注量組(≤60ml·kg-1)相比,其發(fā)生急性腎損傷的OR=16.8(95%CI7.8-36.3,P0.001),輸血漿最大輸注量組(60ml·kg-1)和最小輸注量組(40ml·kg-1)相比,急性腎損傷的OR=6.8(95%CI3.4-13.7,P0.001)。多因素分析發(fā)現(xiàn)年齡≤6個月、圍術(shù)期輸血量和輸血漿量是急性腎損傷的獨立危險因素(OR分別為2.215,1.015和1.020)。在手術(shù)復(fù)雜程度低(Level1+Level2)、體外循環(huán)時間60min或≥60min、術(shù)中最低溫度≥28℃的患兒中,腎損傷組圍術(shù)期輸血量和輸血漿量均顯著多于無腎損傷組。 結(jié)論：輸血量和輸血漿量與小兒心臟體外循環(huán)術(shù)后急性腎損傷呈正相關(guān)。年齡、圍術(shù)期輸血量和和輸血漿量是急性腎損傷的獨立危險因素。選擇合適的手術(shù)年齡、減少圍術(shù)期輸血量可能有助于減少急性腎損傷的發(fā)生。
[Abstract]:Background: children with congenital heart disease (CHD) are at risk of acute renal injury after cardiopulmonary bypass.In recent years, the adverse consequences of blood transfusion are still being discovered, and the study of transfusion associated acute renal injury in children with congenital heart disease is scarce.This study was designed to describe the correlation between blood transfusion and renal injury after cardiopulmonary bypass in children with congenital heart disease.Methods: 487 children with congenital heart disease undergoing cardiopulmonary bypass from January to September 2010 were retrospectively analyzed.Aristotle scores were used to stratify the surgical complexity of children.According to RIFLE criteria, acute renal injury is defined as the serum creatinine level increased by 50% or more than the preoperative value.Results: in the study cohort, 265 men (54.4%) and 222 women (45.6%) had a median age of 19 months.Within 3 days after operation, 68 children with acute renal injury developed acute renal injury.鎵嬫湳澶嶆潅(浜氶噷澹寰瘋瘎鍒嗕負(fù)Level3鍜孡evel4)鐨勬?zhèn)ｅ効鑲炬崯浼ゅ彂鐢熺巼涓庢墜鏈帲?

本文編號：1703783