左心功能中重度不全患儿行左冠状动脉异常起源矫治术后发生急性肾损伤的危险因素分析

Risk factors of acute kidney injury in pediatric anomalous left coronary artery from the pulmonary artery with a moderate or severe left ventricular dysfunction undergoing surgical repair

中文关键词: 左冠状动脉起源异常矫治术  左心功能中重度不全  急性肾损伤

英文关键词: Anomalous left coronary artery from the pulmonary artery repair  Moderate or severe left ventricular dysfunction  Acute kidney injury

中文摘要:

      
目的 回顾性分析左冠状动脉异常起源于肺动脉(anomalous origin of the left coronary artery from the pulmonary artery,ALCAPA)伴左心功能中重度不全的患儿行矫治术后发生急性肾损伤(acute kidney injury,AKI)的危险因素。
方法 选择2010年11月至2017年5月行ALCAPA矫治术伴术前左室射血分数(left ventricular ejection fraction, LVEF)低于50％的患儿43例,男25例,女18例,年龄3个月至14岁。查阅医院电子病例,收集相关围术期临床资料。根据KIDGO标准判断是否发生AKI，将患儿分为两组：非AKI组和AKI组。采用多因素Logistic 回归分析术后AKI的危险因素。
结果 术后发生AKI 31例,AKI发生率为70.5％。AKI组术前Hb含量、术前LVEF和术前血浆肌酐(SCr)浓度明显低于非AKI组(P<0.05)。多因素Logistic 回归分析显示,术前Hb含量升高为保护性因素(OR=0.917,95％CI 0.848～0.992,P=0.031);术前LVEF升高为保护性因素(OR=0.902,95％CI 0.819～0.993,P=0.036);术前肾小球滤过率(GFR)升高为独立危险因素(OR=1.063,95％CI 1.014～1.113,P=0.011)。
结论 ALCAPA伴左心功能中重度不全的患儿行矫治术,术前Hb含量升高和LVEF升高均是术后发生AKI的保护性因素,而术前GFR升高是术后AKI的独立危险因素。

英文摘要:

      
Objective To retrospectively investigate the risk factors of postoperative acute kidney injury (AKI) among pediatric anomalous left coronary artery from the pulmonary artery (ALCAPA) with a moderate or severe left ventricular dysfunction undergoing surgical repair.
Methods Forty-three ALCAPA children with a LVEF ≤ 50％ underwent surgical repair in our medical center between November 2010 and May 2017, 25 males and 18 females, aged from 3 months to 14 years. AKI was defined according to KIDGO criteria, then all the pediatric population were divided into the no-AKI group and the AKI group. The incidence and risk factors of AKI were analyzed by reviewing clinical data from our medical records.
Results Postoperative AKI occurred in 31 cases and the incidence was about 70.5％. Prior to surgery, hemoglobin (Hb), left ventricular ejection fraction (LVEF) and serum creatinine (SCr) were revealed to be significantly lower in the AKI group when compared with the no-AKI group (P < 0.05). In multivariate analysis, both preoperative higher level of Hb (OR = 0.917, 95％ CI 0.848 - 0.992, P = 0.031) and LVEF were protective factors of AKI (OR = 0.902, 95％ CI 0.819 - 0.993, P = 0.036), whereas higher preoperative glomerular filtration rate (GFR) level was proved to be the independent risk factor (OR = 1.063, 95％ CI 1.014 - 1.113, P = 0.011).
Conclusion Among pediatric ALCAPA population with a LVEF less than 50％ underdoing repair, elevated preoperative Hb concentration and LVEF value are protective factors preventing the occurrence of AKI. And higher preoperative GFR level is the independent risk factor.