Clinical Study Of Acute Kidney Injury After Deep Hypothermic Circulatory Arrest In Cardiac Macrovascular Surgery

Background:Acute kidney injury(AKI)is a common and serious complication in the clinic.It is also a common critical illness after cardiac vascular surgery,which seriously affects the prognosis of patients.In recent years,with the extensive development of cardiac vascular surgery,the incidence of postoperative AKI has also increased significantly,and the mortality rate of patients with AKI has also increased significantly.Therefore,early diagnosis and early intervention of AKI after cardiac major vascular surgery have improved the prognosis of patients,which has become an urgent problem in the field of cardiac surgery.Objective:To investigate the incidence of AKI after deep hypothermic circulatory arrest(DHCA),to explore the risk factors and prognosis of postoperative AKI,and to establish a relatively accurate preoperative risk assessment strategy and prevention measures.Methods:The clinical data of 252 patients who underwent deep hypothermic circulatory surgery in our hospital from January 2014 to October 2018 were retrospectively analyzed.The patients were divided into AKI group and non-AKI group according to the AKI diagnostic criteria developed by kidney disease improving global outcomes.The data of the two groups were compared,and the risk factors related to AKI after deep hypothermic circulatory arrest were analyzed by single factor and multivariate logistic regression.Results:Of the 252 patients enrolled,174 were in the AKI group and 78 in the non-AKI group.The incidence of AKI was 69.0%;20 patients died of postoperative hospitalization,all in the AKI group,with a mortality rate of 7.9%(20%)/252),the hospital mortality rate was significantly higher in the AKI group than in the non-AKI group(P<0.001);49 patients with Continuous Renal Replacement Theapy(CRRT)had an incidence of 19.4%(49)./252),the number of deaths in AKI patients requiring CRRT was 12,accounting for 6.9%(12/174)of AKI patients and 24.5%(12/49)of CRRT patients.Univariate analysis showed that the patient's age,body mass index?28kg/m~2,left ventricular ejection fraction<55%,preoperative serum creatinine value?110?mol/l,preoperative estimation of glomerular filtration rate,Cleveland score score and Intraoperative extracorporeal circulation time,intraoperative infusion of red blood cells,intraoperative infusion of plasma,and postoperative mechanical ventilation time?40 h were statistically significant.Multivariate Logisric regression analysis showed statistically significant differences between groups.Indicators included:patient age(OR 1.040 95%CI 1.017-1.064,P=0.001),BMI?28 kg/m2(OR 2.335 95%CI 1.093-4.990,P=0.029),eGFR<90ml/min/1.73m2(OR2.04495%CI 1.082-3.863,P=0.028),preoperative Cleveland score(OR 1.300 95%CI1.054-1.604,P=0.014),intraoperative extracorporeal circulation time(OR 1.009 95%CI1.002-1.017,P=0.014).Conclusion:Cardiac aortic surgery has a high incidence of acute kidney injury after deep hypothermic circulatory arrest.Patients with acute kidney injury have prolonged hospitalization and increased risk of hospitalization death.Patients with age,BMI?28kg/m~2,eGFR<90ml/min/1.73m~2,preoperative Cleveland score,intraoperative extracorporeal circulation time,etc.are independent risk factors for AKI after deep hypothermic circulatory arrest in cardiac macrovascular surgery.