围术期输血与小儿心脏体外循环术后急性肾损伤相关性研究

发布时间：2018-04-03 05:16

  本文选题：输血　切入点：急性肾损伤　出处：《浙江大学》2014年博士论文

【摘要】：研究背景：小儿先天性心脏病(先心病)体外循环术后有发生急性肾损伤的风险。近年来输血相关的不良后果仍在不断被发现,小儿先心病患者中输血相关急性肾损伤的研究很缺乏。本研究旨在描述小儿先心病体外循环术后输血与肾损伤的相关性。 研究方法：回顾性分析2010年1-9月我院487例患有先心病并行体外循环下手术的患儿。使用亚里士多德评分对患儿手术的复杂程度进行分层。根据RIFLE标准,急性肾损伤定义为血清肌酐值较术前值增加50%或以上。 结果：研究队列中男265例(54.4%),女222例(45.6%),中位年龄19个月。术后3天内有68例(14%)的患儿发生了急性肾损伤。手术复杂(亚里士多德评分为Level3和Level4)的患儿肾损伤发生率与手术简单(亚里士多德评分为Level1和Level2)的患儿相比没有统计学差异(21.0%vs12.9%, OR=1.78,95%CI0.91-3.50,P=0.088)；体外循环时间60min的患儿肾损伤发生率低(OR=0.28,95%CI0.16-0.49,P0.001)。大量输血伴随着肾损伤发生率的急剧上升,输血最大输注量组(90ml·kg-1)和最小输注量组(≤60ml·kg-1)相比,其发生急性肾损伤的OR=16.8(95%CI7.8-36.3,P0.001),输血浆最大输注量组(60ml·kg-1)和最小输注量组(40ml·kg-1)相比,急性肾损伤的OR=6.8(95%CI3.4-13.7,P0.001)。多因素分析发现年龄≤6个月、围术期输血量和输血浆量是急性肾损伤的独立危险因素(OR分别为2.215,1.015和1.020)。在手术复杂程度低(Level1+Level2)、体外循环时间60min或≥60min、术中最低温度≥28℃的患儿中,肾损伤组围术期输血量和输血浆量均显著多于无肾损伤组。 结论：输血量和输血浆量与小儿心脏体外循环术后急性肾损伤呈正相关。年龄、围术期输血量和和输血浆量是急性肾损伤的独立危险因素。选择合适的手术年龄、减少围术期输血量可能有助于减少急性肾损伤的发生。
[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�澶氬痉璇勫垎涓篖evel3鍜孡evel4)鐨勬偅鍎胯偩鎹熶激鍙戠敓鐜囦笌鎵嬫湳绠，

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