目的 探讨心血管手术患者肾动脉搏动指数（renal pulsatility index, RPI）与术后发生急性肾损伤（acute kidney injury, AKI）是否存在相关性，以及RPI增高是否能预测AKI的发生。 方法 本研究为前瞻性观察性研究，纳入2019年2月—2019年10月择期全身麻醉下行CPB下心血管手术的患者71例，年龄≥18岁，性别不限。根据改善全球肾脏病预后（Kidney Disease Improving Global Outcomes, KDIGO）分级标准将患者分为两组：AKI组和非AKI组。于麻醉诱导后（T1）、术毕即刻（T2）经食管超声心动图（transesophageal echocardiography, TEE）测RPI；术前1 d、术后1~7 d取静脉血测定血肌酐（serum creatinine, Scr）浓度；Logistic回归分析AKI发生的相关危险因素；受试者工作特征（receiver operating characteristic, ROC）曲线分析RPI对预测AKI的价值，计算曲线下面积（area under the curve, AUC）。 结果 术后发生AKI的患者有19例，发生率为26.8%。与非AKI组比较，AKI组T2时RPI显著增高（P<0.01），T1时RPI差异无统计学意义（P>0.05）。多因素分析显示，T2时RPI为AKI发生的独立预测因子。T2时RPI对AKI诊断的AUC为0.724（95%CI 0.578~0.869，P<0.01）,敏感度57.89%，特异性86.54%，RPI临界值为1.86。 结论 心血管手术患者RPI和AKI发生存在相关性，RPI增高的患者在心血管手术后发生AKI的风险增加。
Objective This study aims to investigate the correlation between renal pulsatility index (RPI) and postoperative acute kidney injury (AKI) in patients undergoing cardiovascular surgery and whether increased RPI can predict AKI. Methods This study is a prospective observational study. From February to October 2019, a total of 71 patients scheduled for elective cardiovascular surgery under elective cardiopulmonary bypass (CPB) under general anesthesia were enrolled in this study. According to Kidney Disease Improving Global Outcomes (KDIGO) classification criteria, patients were divided into two groups: AKI group and non‑AKI group. RPI was measured by transesophageal echocardiography (TEE) after induction of general anesthesia (T1) and at the end of surgery (T2). The concentration of serum creatinine (Scr) was measured at 1 d before surgery and 1‒7 d after surgery. Logistic regression was used to analyze the related risk factors of AKI. The value of RPI was analyzed by receiver operating characteristic (ROC) curve for predicting AKI. The area under the curve (AUC) were calculated. Results Nineteen patients developed AKI after surgery ,with an incidence rate of 26.8%. Compared with the non‑AKI group, RPI in the AKI group was significantly higher at T2 (P<0.01), and there was no significant difference in RPI at T1 (P>0.05). Multivariate analysis showed that RPI at T2 was an independent predictor of AKI. At T2, the AUC for RPI diagnosis of AKI was 0.724 [95% confidence interval (CI) 0.578‒0.869, P<0.01]. The sensitivity was 57.89% while the specificity and the RPI cutoff were 86.54% and 1.86 respectively. Conclusions There was a correlation between RPI and AKI during cardiovascular surgery. Thus, the patients with increased RPI had an increased risk of AKI after cardiovascular surgery. Results: The incidence of AKI was 29.5%. The RPI at time T1 and T2 of patients in the AKI group were 1.4±0.6 and 2.1±0.7 (P0.05), and the RPI at time T1 and T2 of patients in the non-AKI group were 1.2±0.3 and 1.5±0.5 (P0.05). Multivariate analysis showed that RPI at T2 was an independent predictor of AKI. At T2, the AUC for RPI diagnosis of AKI was 0.733 (95% CI 0.621~0.827, P0.01), the sensitivity was 60.87%, the specificity was 85.45%, and the RPI cutoff was 1.86. Conclusions: There was a correlation between RPI and AKI during cardiovascular surgery, and patients with increased RPI had an increased risk of AKI after cardiovascular surgery.
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