Renal Protection Of Lower Limb Ischemic Perconditioning In Adult Valve Replacement

Objective At present,there are not large-scale clinical studies on the renal protection of lower limb ischemia perconditioning in adult valve replacement under cardiopulmonary bypass. The purpose of this study is to investigate the renal protective effect of lower limb ischemia perconditioning in adult valve replacement under CPB.Methods Two hundred and three patients with rheumatic heart valvular disease were randomly divided into two groups:control group (101cases) and remote ischemia perconditioning group (102cases). Control group was placed a tourniquet around the left thigh without inflation; the remote perconditioning group was performed3cycles of5minutes/5minutes left thigh ischemia and reperfusion immediately after aortic cross-clamping, the limb ischemia was induced by inflating the tourniquet to600mmHg. the serum creatinine (Scr),blood urea nitrogen (BUN) and serum cystatin C (Cys-C) concentration of preoperative,12h,24h and48h after aortic de-clamping were measured.Then we calculated creatinine clearance (Ccr) in each time point, the occurrence of acute kidney injury (AKI) and AKI staging.The general information (gender, age, weight, disease, left ventricular ejection fraction, cardiac function grade, atrial fibrillation) of the two groups of patients were recorded. The clinical data (operation time, CPB time, aortic clamping time, perfusion mean arterial pressure, and spontaneous resuscitation,24h after aortic de-clamping inotropic scores, mechanical ventilation time, intensive care time,24h infusion quantity,24h drainage,24h urine volume,tricuspid valvuloplasty, length of hospital stay, and major complications were routinely recorded).Results There was one case died in each group after sugery,because of postoperative low cardiac output syndrome. Compared with the control group,48h serum creatinine after aortic de-clamping in the remote ischemia perconditioning group was significantly lower (86.28±18.49vs111.38±39.29);48h creatinine clearance rate after aortic de-clamping in the remote ischemia perconditioning group increased significantly (74.49±21.07vs64.33±24.29);24h after aortic de-clamping inotropic scores significantly reduced (4.03±2.26vs5.93±3.05);24h urine volume significantly increased (2417.69±704.64vs2035.00±595.04),24h drainage significantly reduced (403.21±271.54vs545.10±349.00). Genera information of the two groups before surgery has no statistical difference. Other intraoperative and postoperative parameters were not significantly different (P>0.05).Conclusion Remote ischemia perconditioning has a protective effect on renal function in adult cardiac valve replacement.