Postoperative Acute Kidney Injury Clinical Trial
Official title:
Correlation Between Monitoring Renal Hemodynamics by Esophageal Ultrasound and Acute Kidney Injury After Heart Surgery.
Acute kidney injury (AKI) is a common complication of cardiac surgery, which seriously
affects the postoperative complication rate and mortality of patients.Acute kidney injury
occurs in 5-30% of patients after cardiac surgery, but severe acute kidney injury requiring
dialysis is relatively rare.At present, the diagnosis of AKI is based on serum creatinine
(Scr) or urine volume. However, the changes of serum creatinine value have hysteresis, and
the increase of serum creatinine level lags behind kidney injury for 48 ~ 72 h.Some drugs can
also affect creatinine levels.Urine volume is also affected by many factors.Due to the lack
of sensitivity and specificity of SCr, it is very important to find and adopt new early AKI
markers.Kidney is an important metabolic organ of human body. Different from cerebrovascular
system, kidney lacks automatic regulation ability and is easily affected by perfusion
flow.Previous experiments have shown that placing a multi-plane esophageal probe into the
human stomach through the esophagus can monitor the changes of left renal blood flow before,
during and after cardiovascular surgery extracorporeal circulation, and has good
repeatability, which may become an effective means to monitor renal blood flow during
cardiovascular surgery.
In conclusion, this study intends to use esophageal ultrasound as a means to monitor renal
blood flow, observe the changes of intraoperative renal hemodynamic indexes, and use KDIGO (
Kidney Disease:Improving Global Outcomes)as the standard of renal injury to explore the
correlation between intraoperative hemodynamic changes and postoperative AKI, providing a new
perspective for the pathophysiological study of AKI after cardiopulmonary bypass.
The mechanism of acute kidney injury after CPB has not been fully elucidated, and current
studies suggest that the main mechanisms are as follows:
(1) endogenous/exogenous nephrotoxic substances;(2) metabolic factors: mainly reflected in
the preoperative status of patients, such as obesity, low body weight, etc.;(3) hemodynamic
factors: hemodynamic instability is an important mechanism for further renal injury process
such as ischemia reperfusion, which is mainly reflected in: a.preoperative and postoperative
hypotension: cardiogenic shock caused by cardiac insufficiency and low cardiac
displacement;Non-cardiogenic shock (vasoactive drugs/allergies/postoperative bleeding);b.
hemodynamic instability of intraoperative intervention: deep anesthesia, intraoperative blood
loss, CPB-related intraoperative low perfusion (long CPB time, low circulation flow, low mean
arterial pressure in CPB), embolic release (atherosclerotic emboli/air emboli), aorta and
distal arteriotomy;(4) neurohumoral system factors: hormones such as epinephrine,
norepinephrine, renin and thyroxine change to varying degrees during cardiac surgery and CPB,
thus affecting the body state and systemic blood vessels;(5) inflammation and oxidative
stress.
Kidney is an important metabolic organ of human body. Different from cerebrovascular system,
kidney lacks automatic regulation ability and is easily affected by perfusion flow.For
patients at high risk of postoperative acute kidney injury, appropriate intraoperative
perfusion may reduce the incidence of postoperative acute kidney injury.
Esophageal ultrasound was used as a means of monitoring renal blood flow to observe the
changes in intraoperative renal hemodynamic indexes. Meanwhile, KDIGO was used as the
standard for renal injury. AKI was divided into two groups according to whether postoperative
AKI occurred, and the correlation between intraoperative hemodynamic changes and
postoperative AKI in the two groups was discussed.It provides new ideas for the early
diagnosis of postoperative acute kidney injury.
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