nefrНефрологияNephrology (Saint-Petersburg)1561-62742541-9439Pavlov First Saint-Petersburg State Medical University10.36485/1561-6274-2020-24-4-37-45nefr-1856Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИ. КЛИНИЧЕСКИЕ ИССЛЕДОВАНИЯORIGINAL ARTICLES. CLINICAL INVESTIGATIONSВлияние искусственного кровообращения на развитие острого повреждения почек после операций на открытом сердцеEffect of cardiopulmonary bypass on the development of acute kidney injury after open-heart surgeryhttps://orcid.org/0000-0002-6313-5856ПолушинЮ. С.PolushinYu. S.

Академик РАН, проф. Полушин Юрий Сергеевич, д-р мед. наук, руководитель научно-клинического центра анестезиологии и реаниматологии, заведующий кафедрой анестезиологии и реаниматологии

197022, Санкт-Петербург, ул. Льва Толстого, д. 6–8

Тел.: +7(812)338-60-77

Acad. RAS, Prof. Yury S. Polushin, MD, PhD, DMedSci

197022, St. Petersburg, L’va Tolstogo str., 6–8

Phone: +7(812)338-60-77

polushin1@gmail.comhttps://orcid.org/0000-0002-7165-4701СоколовД. В.SokolovD. V.

Соколов Дмитрий Васильевич, ассистент кафедры анестезиологии и реаниматологии

197022, Санкт-Петербург, ул. Льва Толстого, д. 6–8

Тел.: +7(911)719-33-33

Dmitry V. Sokolov, MD, faculty assistant

197022, St. Petersburg, L’va Tolstogo str., 6–8.

Phone: +7(911)719-33-33

sokolovdv82@gmail.comhttps://orcid.org/0000-0002-8472-2048МолчанН. С.MolchanN. S.

Молчан Николай Сергеевич, канд. мед. наук, ассистент кафедры анестезиологии и реаниматологии

197022, Санкт-Петербург, ул. Льва Толстого, д. 6–8

Тел.: +7(953)170-07-06

Nikolay S. Molchan, MD, PhD, faculty assistant

197022, St.-Petersburg, L’va Tolstogo str., 6–8

Phone: +7(953)170-07-06

johnwolver2@gmail.comhttps://orcid.org/0000-0001-7689-5152АкмаловаР. В.AkmalovaR. V.

Акмалова Регина Валерьевна

197022, Санкт-Петербург, ул. Льва Толстого, 6–8

Тел.: +7(911)009-12-34

Regina V. Akmalova, MD

197022, St. Petersburg, L’va Tolstogo str., 6–8

Phone: +7(911)009-12-34

regina.akmalova@gmail.comНаучно-клинический центр анестезиологии и реаниматологии, Первый Санкт-Петербургский государственный медицинский университет им. акад. И.П. ПавловаРоссияResearch Clinical Center of Anesthesiology and Intensive Care, Research Institute of Nephrology, Laboratory of Biochemical Homeastasis of the First Pavlov Saint- Petersburg State Medical UniversityRussian Federation2020260620202443745Copyright © Полушин Ю.С., Соколов Д.В., Молчан Н.С., Акмалова Р.В., 20202020Полушин Ю.С., Соколов Д.В., Молчан Н.С., Акмалова Р.В.Polushin Y.S., Sokolov D.V., Molchan N.S., Akmalova R.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nephrolog.ru/jour/article/view/1856

ЦЕЛЬ ИССЛЕДОВАНИЯ. Оценка роли связанных с искусственным кровообращением (ИК) факторов в возникновении дисфункции почек в раннем послеоперационном периоде у кардиохирургических пациентов. ПАЦИЕНТЫ И МЕТОДЫ. Моноцентровое обсервационное исследование среди пациентов (n=97), подвергшихся плановому кардиохирургическому вмешательству на открытом сердце (шунтирование коронарных артерий – 50,44 %, протезирование аортального клапана – 31,04 %, протезирование митрального клапана – 12,61 %) с использованием ИК. Критерии включения: возраст пациентов – старше 18 лет, кардиохирургические вмешательства с использованием ИК длительностью от до 95 мин (коронарное шунтирование, протезирование клапанов), отсутствие признаков терминальной почечной недостаточности. С помощью непараметрического корреляционного анализа оценивали влияние на развитие острого повреждения почек (ОПП) следующих факторов: продолжительности ИК и аноксии, уровней среднего артериального давления (САД), сердечного индекса (СИ), объемной скорости кровотока (ОСК), показателей транспорта, потребления и экстракции кислорода. Диагноз ОПП ставили на основании классификации KDIGO, исследуемые параметры фиксировали исходно (накануне операции), через 15 мин после начала общей анестезии, на 30-й минуте после начала искусственного кровообращения и через 15 мин после завершения общей анестезии. РЕЗУЛЬТАТЫ. Частота ОПП через 24 ч после операции составила 56,3 % (58 случаев): в том числе 1-й стадии у 37 (35,9 %), 2-й стадии – у 17 (16,5 %), 3-й стадии – у 4 (3,9 %) пациентов. На 48-й час послеоперационного периода в ряде случаев признаки ОПП регрессировали, и наличие его констатировали уже всего у 26 человек (25,2 %), в том числе 1-й стадии – у 18 (17,5 %), 2-й стадии – у 5 (4,8 %), 3-й стадии – у 3 (2,9 %). При оценке значимости факторов риска развития ОПП достоверная связь факта дисфункции почек выявлена с анемией, особенно со снижением уровня гемоглобина менее 90 г/л и гематокрита менее 25 %. ЗАКЛЮЧЕНИЕ. Дилюционная анемия ниже «пороговых» значений гемоглобина и гематокрита на этапе ИК влияет на развитие острого повреждения почек у пациентов, подвергающихся кардиохирургическим вмешательствам.

THE AIM. Assessment of factors associated with cardiopulmonary bypass (CPB) in acute renal dysfunction in patients in the early postoperative period after cardiac surgery. PATIENTS AND METHODS. Monocentric observational study in patients (n = 97) who underwent elective open-heart cardiac surgery (coronary artery bypass grafting -50.44 %, aortic valve prosthetics – 31.04 %, mitral valve prosthetics – 12.61 %) using cardiopulmonary bypass. Inclusion criteria: the study included patients not younger than 18 years old, undergoing cardiac surgery with CPB lasting up to 95 minutes (coronary bypass surgery, valve replacement), without signs of end-stage renal disease. Using nonparametric correlation analysis, we evaluated the effect on the development of acute kidney injury (AKI) of the following extracorporeal circulation factors: duration of CPB, aortic cross-clamp, mean arterial pressure (MAP), cardiac index (CI), perfusion flow rate (PFR), transport, consumption, and oxygen extraction variables. The diagnosis of AKI was made on the basis of the KDIGO classification, the studied parameters were recorded initially (before the operation), 15 minutes after the start of general anesthesia, 30 minutes after the start of cardiopulmonary bypass and 15 minutes after the end of general anesthesia. RESULTS. The frequency of AKI in 24 hours after surgery was 56.3 % (58 cases): including stage 1 in 37 (35.9 %), stage 2 in 17 (16.5 %) , stage 3 – in 4 (3.9 %) patients. In the 48th hour of the postoperative period, signs of AKI regressed and were presented in only 26 people (25.2 %), including the stage 1 in 18 (17.5 %), the stage 2 – in 5 (4.8 %), stage 3 – in 3 (2.9 %). Among the risk factors for AKI in cardiac surgery with CPB, the main effect of the anemia was revealed, especially a decrease in hemoglobin levels of less than 90 g / l and hematocrit of less than 25 %. CONCLUSION. Hemodilution below the "threshold" values of hemoglobin and hematocrit during the CPB provoke acute kidney injury in patients undergoing open-heart surgery.

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The authors declare that there are no conflicts of interest present.