Objective: To study the association between fluid overload and acute kidney injury (AKI) after congenital heart disease surgery in infants.
Methods: A retrospective analysis was performed on 88 infants aged less than 6 months who underwent a radical surgery for congenital heart disease. The treatment outcomes were compared between the infants with AKI after surgery and those without. The effect of cumulative fluid overload on treatment outcomes 2 days after surgery was analyzed. The risk factors for the development of AKI after surgery were assessed by logistic regression analysis.
Results: Compared with those without AKI after surgery, the patients with AKI had younger age, lower body weights, higher serum creatinine levels and higher vasoactive-inotropic score, as well as longer durations of intraoperative extracorporeal circulation and aortic occlusion (P<0.05). Compared with those without AKI after surgery, the patients with AKI had a higher transfusion volume, a higher incidence rate of low cardiac output syndrome, a longer duration of mechanical ventilation, a longer length of stay in the intensive care unit (ICU), a longer length of hospital stay, a higher application rate of extracorporeal membrane oxygenation, a higher 30-day mortality rate, and higher levels of cumulative fluid overload 2 and 3 days after surgery (P<0.05). The logistic regression analysis showed that fluid overload and low cardiac output syndrome were major risk factors for the development of AKI after surgery. The children with cumulative fluid overload >5% at 2 days after surgery had a higher incidence rate of low cardiac output syndrome, a longer duration of mechanical ventilation, a longer length of stay in the ICU, a longer length of hospital stay, and a higher mortality rate (P<0.05).
Conclusions: Infants with fluid overload after surgery for congenital heart disease tend to develop AKI, and fluid overload may be associated with poor outcomes after surgery.
目的: 探讨液体超负荷与婴儿先天性心脏病术后急性肾损伤（AKI）的关系。
方法: 对88例年龄 < 6个月的行先天性心脏病根治术患儿进行回顾性研究。比较术后是否合并AKI患儿的治疗结局，以及术后第2天累积液体超负荷对治疗结局的影响，并分析术后AKI发生的影响因素。
结果: 与术后无AKI患儿比较，合并AKI者年龄更小、体重更低，血肌酐、血管活性药物评分更高，术中体外循环时间和主动脉阻断时间更长，输血量更多、低心排综合征发生率更高，机械通气时间、ICU停留时间、住院时间更长，体外膜肺氧和使用率以及30 d死亡率更高，术后第2、3天的累积液体超负荷更高（P < 0.05）。Logistic回归分析提示液体超负荷、低心排综合征是术后发生AKI的主要影响因素。术后第2天累积液体超负荷> 5%的患儿低心排综合征发生率、机械通气时间、ICU停留时间和住院时间较长，死亡率较高（P < 0.05）。
结论: 先天性心脏病术后液体超负荷的婴儿易发生AKI，液体超负荷可能与术后不良结局有关。