目的:研究脑内局部血氧饱和度(rSO2)的预测价值,小儿先天性心脏病术后急性肾损伤(AKI)的肠和肾脏治疗。
方法:57例先天性心脏病(CHD)儿童,体重>2.5公斤,年龄≤1岁,在上海儿童医疗中心接受治疗,上海交通大学医学院,2020年1月至2020年12月。大脑的rSO2,术后48h采用近红外光谱连续监测肠和肾脏。大脑的预测值,对肠肾rSO2术后AKI的发生和严重程度进行分析。
结果:在57例患者中,术后发生AKI38例(66.7%),包括18例AKI-1(47.4%),AKI-29例(23.7%),AKI-311例(28.9%)。AKI组和非AKI组之间的脑rSO2差异无统计学意义(F=0.012,P>0.05)。而AKI组的肠rSO2和肾rSO2明显低于非AKI组(F=5.017和5.003,均P<0.05)。有或没有AKI-2及以上患儿的脑rSO2无显著差异(F=0.311,P>0.05),但AKI-2及以上患儿的肠道rSO2和肾脏rSO2低于其他患儿(F=6.431和14.139,均P<0.05)。术后3h肠rSO2预测AKI的ROC曲线下面积(AUC)为0.823,术后3h肠rSO2<85%,敏感性和特异性分别为66.7%和89.5%,分别。术后31h肾rSO2诊断AKI的AUC为0.918,术后31h肠rSO2<84%,敏感性和特异性分别为72.2%和84.2%,分别。术后23h肠rSO诊断为AKI-2及以上的AUC为0.829,术后3h肠rSO2<84%,敏感性和特异性分别为62.2%和90.0%,分别。术后34h肾rSO2诊断AKI-2及以上的AUC为0.826,手术后34h肠道rSO2<71%,敏感性和特异性分别为91.9%和55.0%,分别。
结论:肠肾rSO2监测可预测先天性心脏病患儿术后AKI的发生及严重程度。
OBJECTIVE: To study the prediction value of regional oxygen saturation (rSO 2) in brain, intestine and kidney for acute kidney injury (AKI) in children with congenital heart disease after surgery.
METHODS: Fifty-seven children with congenital heart disease (CHD), whose weight >2.5 kg and age≤1 year were treated in Shanghai Children\'s Medical Center, Shanghai Jiao Tong University School of Medicine from January 2020 to December 2020. The rSO 2 of brain, intestine and kidney were monitored with near-infrared spectroscopy continuously for 48 h after surgery. The predictive values of cerebral, intestinal and renal rSO 2 for occurrence and severity of postoperative AKI were analyzed.
RESULTS: Among 57 patients, postoperative AKI developed in 38 cases (66.7%), including 18 cases of AKI-1 (47.4%), 9 cases of AKI-2 (23.7%) and 11 cases of AKI-3 (28.9%). There was no significant difference in cerebral rSO 2 between AKI group and non-AKI group ( F=0.012, P>0.05), while the intestinal rSO 2 and renal rSO 2 in AKI group were significantly lower than those in non-AKI group ( F=5.017 and 5.003, both P<0.05). There was no significant difference in brain rSO 2 between children with or without AKI-2 and above ( F=0.311, P>0.05), but the intestinal rSO 2 and renal rSO 2 in children with AKI-2 and above were lower than other children ( F=6.431 and 14.139, both P<0.05). The area under ROC curve (AUC) of intestinal rSO 2 3 h after surgery for predicting AKI was 0.823, and with intestinal rSO 2 3 h after surgery <85%, the sensitivity and specificity were 66.7% and 89.5%, respectively. The AUC of renal rSO 2 for the diagnosis of AKI at 31 h after surgery was 0.918, and with intestinal rSO 2 31 h after surgery <84%, the sensitivity and specificity were 72.2% and 84.2%, respectively. The AUC of intestinal rSO 23 h after surgery for the diagnosis of AKI-2 and above was 0.829, and with intestinal rSO 2 3 h after surgery <84%, the sensitivity and specificity were 62.2% and 90.0%, respectively. The AUC of renal rSO 2 for the diagnosis of AKI-2 and above was 0.826 at 34 h postoperatively, and with intestinal rSO 2 34 h after surgery <71%, the sensitivity and specificity were 91.9% and 55.0%, respectively.
CONCLUSIONS: The monitoring of intestinal and renal rSO 2 can predict the occurrence and severity of postoperative AKI in children with congenital heart disease after surgery.