【罂粟摘要】无创尿氧监测与心脏手术中急性肾损伤的风险
无创尿氧监测与心脏手术中急性肾损伤的风险
贵州医科大学 高鸿教授课题组
翻译：任文鑫 编辑：佟睿 审校：曹莹
急性肾损伤(AKI)是心脏手术的常见并发症。术中需要对肾脏灌注进行监测，以确定有AKI风险患者。作者发明了一种无创尿氧饱和度仪，可连续测量尿液氧分压和瞬时尿流量。他们假设，使用该原型装置进行术中尿液氧分压测量是可行的，并且心脏手术期间的低尿液氧分压与AKI的后续发展相关。
这是一项前瞻性观察性试点研究。在91名接受心脏手术的患者中，使用放置在导尿管和收集袋之间的新型装置，测量了连续尿液氧分压和瞬时尿流量。数据收集在整个手术过程中和术后24小时。临床医生对术中尿液氧分压和瞬时流量数据不知情。术后对患者进行随访，并将AKI的发生率与尿液氧分压测量值进行比较。
术中尿液氧分压测量在86/91（95%）患者中可行。当尿液氧分压数据被过滤为大于0.5 ml·kg–1·h–1的有效尿流量时，那么在体外循环（CPB）期间和CPB后，分别有70/86（81%）和77/86（90%）的病人被纳入分析。随后发生AKI的患者在CPB术后的平均尿液氧分压显著低于未发生AKI的患者（平均差异6 mmHg；95%可信区间0～11；P=0.038）。在多变量分析中，CPB后的平均尿氧液分压仍然是AKI的独立风险因素（相对风险，0.82；95%CI，0.71至0.95；平均尿液氧分压每增加10mmHg，P = 0.00）。
CPB后尿液氧分压低可能与心脏手术后AKI的发生有关。
Natalie A. Silverton, Lars R. Lofgren, B.S., Isaac E. Hall, Gregory J. Stoddard,et al,Noninvasive Urine Oxygen Monitoring and the Risk of Acute Kidney Injury in Cardiac Surgery。[J]. ANESTHESIOLOGY 2021; 135:406–18.
Noninvasive Urine Oxygen Monitoring and the Risk of Acute Kidney Injury in Cardiac Surgery
Background: Acute kidney injury (AKI) is a common complication of cardiac surgery. An intraoperative monitor of kidney perfusion is needed to identify patients at risk for AKI. The authors created a noninvasive urinary oximeter that provides continuous measurements of urinary oxygen partial pressure and instantaneous urine flow. They hypothesized that intraoperative urinary oxygen partial pressure measurements are feasible with this prototype device and that low urinary oxygen partial pressure during cardiac surgery is associated with the subsequent development of AKI.
Methods: This was a prospective observational pilot study. Continuous urinary oxygen partial pressure and instantaneous urine flow were measured in 91 patients undergoing cardiac surgery using a novel device placed between the urinary catheter and collecting bag. Data were collected throughout the surgery and for 24 h postoperatively. Clinicians were blinded to the intraoperative urinary oxygen partial pressure and instantaneous flow data. Patients were then followed postoperatively, and the incidence of AKI was compared to urinary oxygen partial pressure measurements.
Results: Intraoperative urinary oxygen partial pressure measurements were feasible in 86/91 (95%) of patients. When urinary oxygen partial pressure data were filtered for valid urine flows greater than 0.5 ml · kg–1 · h–1, then 70/86 (81%) and 77/86 (90%) of patients in the cardiopulmonary bypass (CPB) and post-CPB periods, respectively, were included in the analysis. Mean urinary oxygen partial pressure in the post-CPB period was significantly lower in patients who subsequently developed AKI than in those who did not (mean difference, 6 mmHg; 95% CI, 0 to 11; P = 0.038). In a multivariable analysis, mean urinary oxygen partial pressure during the post-CPB period remained an independent risk factor for AKI (relative risk, 0.82; 95% CI, 0.71 to 0.95; P = 0.009 for every 10-mmHg increase in mean urinary oxygen partial pressure).
Conclusions: Low urinary oxygen partial pressures after CPB may be associated with the subsequent development of AKI after cardiac surgery.
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