先天性心臟病體外循環(huán)術(shù)后合并急性腎損傷患兒的臨床特點(diǎn)及預(yù)后分析
發(fā)布時(shí)間：2018-12-23 13:01
【摘要】：目的分析體外循環(huán)(CPB)手術(shù)后合并急性腎損傷(AKI)的先天性心臟病患兒圍術(shù)期臨床資料,探討有無(wú)改善預(yù)后的可調(diào)節(jié)因素。方法針對(duì)小兒先心病CPB手術(shù)后48 h內(nèi)發(fā)生AKI的118例患者進(jìn)行回顧性分析。結(jié)果 118例中手術(shù)后48 h后死亡的18例。與存活組相比,死亡組術(shù)前的紫紺型心臟病所占比例、先天性心臟病手術(shù)風(fēng)險(xiǎn)評(píng)估共識(shí)評(píng)分均較高;術(shù)中CPB時(shí)間和升主動(dòng)脈阻斷時(shí)間、采用全晶體液進(jìn)行心肌保護(hù)的比例、術(shù)中平均血糖均較高;術(shù)后48 h內(nèi)正性肌力藥物分值(IS)、術(shù)后肌酐值、3級(jí)AKI所占比例、采用腎臟替代療法進(jìn)行治療的比例、紅細(xì)胞或其它血制品輸注數(shù)量均較高,差異均具有統(tǒng)計(jì)學(xué)意義(P0.05)。術(shù)后死亡率隨著術(shù)中平均血糖升高而增加,有線性關(guān)聯(lián)(P0.05)。術(shù)中平均血糖8.3 mmol/L的患兒累積生存率和平均生存期均低于血糖≤8.3 mmol/L者(P0.05)。結(jié)論先天性心臟病CPB術(shù)后合并AKI患兒的術(shù)中血糖水平與預(yù)后相關(guān),術(shù)中嚴(yán)格控制血糖上升對(duì)改善CPB術(shù)后AKI患兒的預(yù)后有積極作用。
[Abstract]:Objective to analyze the perioperative clinical data of children with congenital heart disease complicated with acute renal injury (AKI) after (CPB) operation under cardiopulmonary bypass (CPB), and to explore the possible prognostic factors. Methods 118 children with congenital heart disease who developed AKI within 48 hours after CPB operation were retrospectively analyzed. Results of 118 cases, 18 died 48 hours after operation. Compared with the survival group, the proportion of preoperative cyanotic heart disease in the death group and the consensus score of surgical risk assessment for congenital heart disease were higher. Intraoperative CPB time and ascending aorta occlusion time, total crystal solution for myocardial protection, the average intraoperative blood glucose was higher; Positive creatine score within 48 hours after operation, creatinine value after (IS), the proportion of AKI of grade 3, the proportion of renal replacement therapy, the quantity of red blood cells or other blood products were higher. The difference was statistically significant (P0.05). Postoperative mortality increased with the increase of intraoperative mean blood glucose (P 0.05). The cumulative survival rate and mean survival time of children with intraoperative mean blood glucose 8.3 mmol/L were lower than those with blood glucose 鈮，
本文編號(hào)：2390018
[Abstract]:Objective to analyze the perioperative clinical data of children with congenital heart disease complicated with acute renal injury (AKI) after (CPB) operation under cardiopulmonary bypass (CPB), and to explore the possible prognostic factors. Methods 118 children with congenital heart disease who developed AKI within 48 hours after CPB operation were retrospectively analyzed. Results of 118 cases, 18 died 48 hours after operation. Compared with the survival group, the proportion of preoperative cyanotic heart disease in the death group and the consensus score of surgical risk assessment for congenital heart disease were higher. Intraoperative CPB time and ascending aorta occlusion time, total crystal solution for myocardial protection, the average intraoperative blood glucose was higher; Positive creatine score within 48 hours after operation, creatinine value after (IS), the proportion of AKI of grade 3, the proportion of renal replacement therapy, the quantity of red blood cells or other blood products were higher. The difference was statistically significant (P0.05). Postoperative mortality increased with the increase of intraoperative mean blood glucose (P 0.05). The cumulative survival rate and mean survival time of children with intraoperative mean blood glucose 8.3 mmol/L were lower than those with blood glucose 鈮，
本文編號(hào)：2390018
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