先天性心脏病小儿术后急性肾损伤的临床危险因素分析

张竞文; 游嘉; 陈勤; 肖锐; 李洪; 杜智勇; 黄河; 杨天德

doi:10.16016/j.1000-5404.201611112

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先天性心脏病小儿术后急性肾损伤的临床危险因素分析

临床医学 | 更新时间：2026-01-09

- 先天性心脏病小儿术后急性肾损伤的临床危险因素分析
- Clinically relevant risk factors for acute kidney injury after pediatric congenital heart surgery
- 第三军医大学学报 2017年39卷第9期页码：929-934
- 作者机构：
- 作者简介：
- 基金信息：
- DOI：10.16016/j.1000-5404.201611112
  中图分类号：
- 收稿：2016-11-12，
  
  纸质出版：2017-05-15
- 稿件说明：
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张竞文, 游嘉, 陈勤, 等. 先天性心脏病小儿术后急性肾损伤的临床危险因素分析[J]. 第三军医大学学报, 2017,39(9):929-934.

Jingwen Zhang, Jia You, Qin Chen, et al. Clinically relevant risk factors for acute kidney injury after pediatric congenital heart surgery[J]. Journal of Third Military Medical University, 2017, 39(9): 929-934.
张竞文, 游嘉, 陈勤, 等. 先天性心脏病小儿术后急性肾损伤的临床危险因素分析[J]. 第三军医大学学报, 2017,39(9):929-934. DOI： 10.16016/j.1000-5404.201611112.

Jingwen Zhang, Jia You, Qin Chen, et al. Clinically relevant risk factors for acute kidney injury after pediatric congenital heart surgery[J]. Journal of Third Military Medical University, 2017, 39(9): 929-934. DOI： 10.16016/j.1000-5404.201611112.

摘要

Abstract

Objective

To investigate the risk factors for acute kidney injury (AKI) in children aged < 4 years old following congenital heart surgery.

Methods

Clinical data of pediatric patients (younger than 4 years old) undergoing congenital heart surgery in our hospital from April 2015 to April 2016 were collected. The modified criteria of pediatric risk

injury

and failure

and loss

and end-stage kidney disease (pRIFLE) were used to detect the incidence of AKI. The differences between the children with AKI and without were analyzed. Multivariate logistic regression analysis was employed to study the risk factors of AKI following congenital heart surgery.

Results

Of the 298 patients subjected

there were 152 boys and 146 girls. The incidence of AKI accounted for 35.91% (107 cases)

and 82 children (27.52%) attained at risk stage

16 (5.37%) at injury stage

and 9 (3.02%) at failure stage. Compared with the children without AKI

those with AKI had younger age

shorter height

lower weight and lower Scr pre-operatively

but more complications of preoperative cyanosis and comorbidities

higher class in American Society of Anesthesiologists (ASA) physical status classification system

longer duration of surgery

cardiac pulmonary bypass (CPB) time

and aortic clamping time (ACT). They also had higher levels of urea

uric acid

serum creatinine (Scr)

cystatin-C and retinol-binding protein

but lower estimated creatinine clearance (eCCl)

longer hospital stay and higher mortality after surgery. Logistic regression analysis showed that younger than 1 year old

cynosis

lower pre-operative Scr

and longer duration of surgery were independent risk factors for AKI.

Conclusion

Younger than 1 year old

complication of cynosis

lower pre-operative Scr

and longer duration of surgery significantly increase the incidence of AKI after congenital heart surgery.

关键词

Keywords

references

余章斌韩树萍陈小慧系统评价国内外围产儿先天性心脏病的发生率中国循证儿科杂志 2014 9 4 252 259 http://www.cnki.com.cn/Article/CJFDTOTAL-XZEK201404004.htm 余章斌, 韩树萍, 陈小慧, 等.系统评价国内外围产儿先天性心脏病的发生率[J].中国循证儿科杂志, 2014, 9(4): 252-259.

Yu Z B Han S P Chen X H Systematic review of the prevalence of perinatal congenital heart disease Chinese Journal of Evidence-Based Pediatrics 2014 9 4 252 259 http://www.cnki.com.cn/Article/CJFDTOTAL-XZEK201404004.htm Yu Z B, Han S P, Chen X H, et al. Systematic review of the prevalence of perinatal congenital heart disease[J]. Chinese Journal of Evidence-Based Pediatrics, 2014, 9(4):252-259.

Li S Krawczeski C D Zappitelli M Incidence, risk factors, and outcomes of acute kidney injury after pediatric cardiac surgery: a prospective multicenter study Crit Care Med 2011 39 6 1493 1499 10.1097/CCM.0b013e31821201d3 Li S, Krawczeski C D, Zappitelli M, et al. Incidence, risk factors, and outcomes of acute kidney injury after pediatric cardiac surgery: a prospective multicenter study[J]. Crit Care Med, 2011, 39(6): 1493-1499. DOI:10.1097/CCM. 0b013e31821201d3.

Volpon L C Sugo E K Consulin J C Epidemiology and Outcome of Acute Kidney Injury According to Pediatric Risk, Injury, Failure, Loss, End-Stage Renal Disease and Kidney Disease: Improving Global Outcomes Criteria in Critically Ⅲ Children-A Prospective Study Pediatr Crit Care Med 2016 17 5 e229 e238 10.1097/PCC.0000000000000685 Volpon L C, Sugo E K, Consulin J C, et al. Epidemiology and Outcome of Acute Kidney Injury According to Pediatric Risk, Injury, Failure, Loss, End-Stage Renal Disease and Kidney Disease: Improving Global Outcomes Criteria in Critically Ⅲ Children-A Prospective Study[J]. Pediatr Crit Care Med, 2016, 17(5): e229-e238. DOI:10.1097/PCC.0000 000000000685.

Cabral F C Ramos Garcia P C Mattiello R Influence of Acute Kidney Injury Defined by the Pediatric Risk, Injury, Failure, Loss, End-Stage Renal Disease Score on the Clinical Course of PICU Patients Pediatr Crit Care Med 2015 16 8 e275 e282 10.1097/PCC.0000000000000516 Cabral F C, Ramos Garcia P C, Mattiello R, et al. Influence of Acute Kidney Injury Defined by the Pediatric Risk, Injury, Failure, Loss, End-Stage Renal Disease Score on the Clinical Course of PICU Patients[J]. Pediatr Crit Care Med, 2015, 16(8): e275-e282. DOI:10.1097/PCC.0000000000000516.

Gil-Ruiz Gil-Esparza M A Alcaraz Romero A J Romero Otero A Prognostic relevance of early AKI according to pRIFLE criteria in children undergoing cardiac surgery Pediatr Nephrol 2014 29 7 1265 1272 10.1007/s00467-014-2757-z Gil-Ruiz Gil-Esparza M A, Alcaraz Romero A J, Romero Otero A, et al. Prognostic relevance of early AKI according to pRIFLE criteria in children undergoing cardiac surgery[J]. Pediatr Nephrol, 2014, 29(7): 1265-1272. DOI:10.1007/s00467-014-2757-z.

Watkins S C Williamson K Davidson M Long-term mortality associated with acute kidney injury in children following congenital cardiac surgery Paediatr Anaesth 2014 24 9 919 926 10.1111/pan.12419 Watkins S C, Williamson K, Davidson M, et al. Long-term mortality associated with acute kidney injury in children following congenital cardiac surgery[J]. Paediatr Anaesth, 2014, 24(9): 919-926. DOI:10.1111/pan.12419.

dos Santos E l Halal M G Carvalho P R Acute kidney injury according to pediatric RIFLE criteria is associated with negative outcomes after heart surgery in children Pediatr Nephrol 2013 28 8 1307 1314 10.1007/s00467-013-2495-7 dos Santos E l Halal M G, Carvalho P R. Acute kidney injury according to pediatric RIFLE criteria is associated with negative outcomes after heart surgery in children[J]. Pediatr Nephrol, 2013, 28(8): 1307-1314. DOI:10.1007/s00467-013-2495-7.

Blinder J J Goldstein S L Lee V V Congenital heart surgery in infants: effects of acute kidney injury on outcomes J Thorac Cardiovasc Surg 2012 143 2 368 374 10.1016/j.jtcvs.2011.06.021 Blinder J J, Goldstein S L, Lee V V, et al. Congenital heart surgery in infants: effects of acute kidney injury on outcomes[J]. J Thorac Cardiovasc Surg, 2012, 143(2): 368-374. DOI:10.1016/j.jtcvs.2011.06.021.

Park S K Hur M Kim E Risk Factors for Acute Kidney Injury after Congenital Cardiac Surgery in Infants and Children: A Retrospective Observational Study PLoS ONE 2016 11 11 e0166328 10.1371/journal.pone.0166328 Park S K, Hur M, Kim E, et al. Risk Factors for Acute Kidney Injury after Congenital Cardiac Surgery in Infants and Children: A Retrospective Observational Study[J]. PLoS ONE, 2016, 11(11): e0166328. DOI:10.1371/journal.pone.0166328.

温昱鹏常诚王仲伦儿童非紫绀型先心病体外循环术后急性肾损伤相关危险因素分析天津医药 2015 43 5 515 517 10.11958/j.issn.0253-9896.2015.05.018 温昱鹏, 常诚, 王仲伦, 等.儿童非紫绀型先心病体外循环术后急性肾损伤相关危险因素分析[J].天津医药, 2015, 43(5): 515-517. DOI:10.11958/j.issn.0253-9896. 2015.05.018.

Wen Y P Chang C Wang Z L Risk factors for acute kidney injury after cardiopulmonary bypass operation in children with non cyanotic congenitaI heart disease Tianjin Med J 2015 43 5 515 517 10.11958/j.issn.0253-9896.2015.05.018 Wen Y P, Chang C, Wang Z L, et al. Risk factors for acute kidney injury after cardiopulmonary bypass operation in children with non cyanotic congenitaI heart disease[J]. Tianjin Med J, 2015, 43(5):515-517. DOI: 10.11958/j.issn.0253-9896.2015.05.018.

王韦乐张苗王东进儿童先天性心脏病术后急性肾损伤相关临床危险因素分析东南大学学报 (医学版) 2014 33 2 177 181 10.3969/j.issn.1671-6264.2014.02.016 王韦乐, 张苗, 王东进.儿童先天性心脏病术后急性肾损伤相关临床危险因素分析[J].东南大学学报 (医学版), 2014, 33(2): 177-181. DOI:10.3969/j.issn.1671-6264.2014.02.016.

Wang W L Zhang M Wang D J Risk factors for acute kidney injury after congenital heart surgery in children Journal of Southeast University (Medical Science Edition) 2014 33 2 177 181 10.3969/j.issn.1671-6264.2014.02.016 Wang W L, Zhang M, Wang D J, et al. Risk factors for acute kidney injury after congenital heart surgery in children[J]. Journal of Southeast University (Medical Science Edition), 2014, 33(2):177-181.DOI: 10.3969/j.issn.1671-6264. 2014.02.016.

Lex D J Tóth R Cser p Z A comparison of the systems for the identification of postoperative acute kidney injury in pediatric cardiac patients Ann Thorac Surg 2014 97 1 202 210 10.1016/j.athoracsur.2013.09.014 Lex D J, Tóth R, Cser p Z, et al. A comparison of the systems for the identification of postoperative acute kidney injury in pediatric cardiac patients[J]. Ann Thorac Surg, 2014, 97(1): 202-210. DOI:10.1016/j.athoracsur. 2013.09.014.

Plötz F B Bouma A B van Wijk J A Pediatric acute kidney injury in the ICU: an independent evaluation of pRIFLE criteria Intensive Care Med 2008 34 9 1713 1717 10.1007/s00134-008-1176-7 Plötz F B, Bouma A B, van Wijk J A, et al. Pediatric acute kidney injury in the ICU: an independent evaluation of pRIFLE criteria[J]. Intensive Care Med, 2008, 34(9): 1713-1717. DOI:10.1007/s00134-008-1176-7.

Jenkins K J Gauvreau K Newburger J W Consensus-based method for risk adjustment for surgery for congenital heart disease J Thorac Cardiovasc Surg 2002 123 1 110 118 10.1067/mtc.2002.119064 Jenkins K J, Gauvreau K, Newburger J W, et al. Consensus-based method for risk adjustment for surgery for congenital heart disease[J]. J Thorac Cardiovasc Surg, 2002, 123(1): 110-118. DOI:10.1067/mtc.2002.119064.

de Souza V Cochat P Rabilloud M Accuracy of different equations in estimating GFR in pediatric kidney transplant recipients Clin J Am Soc Nephrol 2015 10 3 463 470 10.2215/CJN.06300614 de Souza V, Cochat P, Rabilloud M, et al. Accuracy of different equations in estimating GFR in pediatric kidney transplant recipients[J]. Clin J Am Soc Nephrol, 2015, 10(3): 463-470. DOI:10.2215/CJN.06300614.

Zappitelli M Bernier P L Saczkowski R S A small post-operative rise in serum creatinine predicts acute kidney injury in children undergoing cardiac surgery Kidney Int 2009 76 8 885 892 10.1038/ki.2009.270 Zappitelli M, Bernier P L, Saczkowski R S, et al. A small post-operative rise in serum creatinine predicts acute kidney injury in children undergoing cardiac surgery[J]. Kidney Int, 2009, 76(8): 885-892. DOI:10.1038/ki.2009.270.

Botwinski C A Falco G A Transition to postnatal renal function J Perinat Neonatal Nurs 2014 28 2 150 154 10.1097/JPN.0000000000000024 Botwinski C A, Falco G A. Transition to postnatal renal function[J]. J Perinat Neonatal Nurs, 2014, 28(2): 150-154. DOI:10.1097/JPN.0000000000000024.

Sulemanji M Vakili K Neonatal renal physiology Semin Pediatr Surg 2013 22 4 195 198 10.1053/j.sempedsurg.2013.10.008 Sulemanji M, Vakili K. Neonatal renal physiology[J]. Semin Pediatr Surg, 2013, 22(4): 195-198. DOI:10.1053/j.sempedsurg.2013.10.008.

Rhodin M M Anderson B J Peters A M Human renal function maturation: a quantitative description using weight and postmenstrual age Pediatr Nephrol 2009 24 1 67 76 10.1007/s00467-008-0997-5 Rhodin M M, Anderson B J, Peters A M, et al. Human renal function maturation: a quantitative description using weight and postmenstrual age[J]. Pediatr Nephrol, 2009, 24(1): 67-76. DOI:10.1007/s00467-008-0997-5.

Boldt J Brenner T Lehmann A Is kidney function altered by the duration of cardiopulmonary bypass Ann Thorac Surg 2003 75 3 906 912 10.1016/s0003-4975(02)04559-9 Boldt J, Brenner T, Lehmann A, et al. Is kidney function altered by the duration of cardiopulmonary bypass[J]. Ann Thorac Surg, 2003, 75(3): 906-912. DOI:10.1016/s0003-4975(02)04559-9.

Fischer U M Weissenberger W K Warters R D Impact of cardiopulmonary bypass management on postcardiac surgery renal function Perfusion 2002 17 6 401 406 10.1191/0267659102pf610oa Fischer U M, Weissenberger W K, Warters R D, et al. Impact of cardiopulmonary bypass management on postcardiac surgery renal function[J]. Perfusion, 2002, 17(6): 401-406. DOI:10.1191/0267659102pf610oa.

Ranucci M Romitti F Isgr G Oxygen delivery during cardiopulmonary bypass and acute renal failure after coronary operations Ann Thorac Surg 2005 80 6 2213 2220 10.1016/j.athoracsur.2005.05.069 Ranucci M, Romitti F, Isgr G, et al. Oxygen delivery during cardiopulmonary bypass and acute renal failure after coronary operations[J]. Ann Thorac Surg, 2005, 80(6):2213-2220. DOI: 10.1016/j.athoracsur.2005.05.069.

Rodieux F Wilbaux M van den Anker J N Effect of Kidney Function on Drug Kinetics and Dosing in Neonates, Infants, and Children Clin Pharmacokinet 2015 54 12 1183 1204 10.1007/s40262-015-0298-7 Rodieux F, Wilbaux M, van den Anker J N, et al. Effect of Kidney Function on Drug Kinetics and Dosing in Neonates, Infants, and Children[J]. Clin Pharmacokinet, 2015, 54(12): 1183-1204. DOI:10.1007/s40262-015-0298-7.

Makaritsis K P Liakopoulos V Leivaditis K Adaptation of renal function in heart failure Ren Fail 2006 28 7 527 535 10.1080/08860220600839522 Makaritsis K P, Liakopoulos V, Leivaditis K, et al. Adaptation of renal function in heart failure[J]. Ren Fail, 2006, 28(7): 527-535. DOI:10.1080/08860220600839522.

Baxmann A C Ahmed M S Marques N C Influence of muscle mass and physical activity on serum and urinary creatinine and serum cystatin C Clin J Am Soc Nephrol 2008 3 2 348 354 10.2215/CJN.02870707 Baxmann A C, Ahmed M S, Marques N C, et al. Influence of muscle mass and physical activity on serum and urinary creatinine and serum cystatin C[J]. Clin J Am Soc Nephrol, 2008, 3(2): 348-354. DOI:10.2215/CJN.02870707.

Inaba M Kurajoh M Okuno S Poor muscle quality rather than reduced lean body mass is responsible for the lower serum creatinine level in hemodialysis patients with diabetes mellitus Clin Nephrol 2010 74 4 266 272 https://www.ncbi.nlm.nih.gov/pubmed/20875378 Inaba M, Kurajoh M, Okuno S, et al. Poor muscle quality rather than reduced lean body mass is responsible for the lower serum creatinine level in hemodialysis patients with diabetes mellitus[J]. Clin Nephrol, 2010, 74(4): 266-272.

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