Intra-abdominal Hypertension and Postoperative Kidney Dysfunction in Cardiac Surgery Patients

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• 作者：Michael A. Mazzeffi ; MD ; MPH^* ; ^{mmazzeffi@anes.umm.edu} ; Patrick Stafford ; BS^&dagger ; ; Karin Wallace ; RN^* ; Wendy Bernstein ; MD ; MBA^* ; Seema Deshpande ; MD^* ; Patrick Odonkor ; MD^* ; Ashanpreet Grewal ; MD^* ; Erik Strauss ; MD^* ; Latoya Stubbs ; BS^* ; James Gammie ; MD^&Dagger ; ; Peter Rock ; MD ; MBA^*
• 关键词：intra-abdominal hypertension ; acute kidney injury ; postoperative kidney dysfunction ; complications ; cardiac surgery ; NGAL
• 刊名：Journal of Cardiothoracic and Vascular Anesthesia
• 出版年：2016
• 出版时间：December 2016
• 年：2016
• 卷：30
• 期：6
• 页码：1571-1577
• 全文大小：564 K
• 卷排序：30

文摘

To determine the incidence of intra-abdominal hypertension (IAH) in adult cardiac surgery patients and its association with postoperative kidney dysfunction.DesignProspective cohort study.SettingSingle tertiary-care university hospital.ParticipantsForty-two adult patients having cardiac surgery with cardiopulmonary bypass.InterventionsIntra-abdominal pressure (IAP) was measured preoperatively, immediately after surgery, and at the following time points after surgery: 3 hours, 6 hours, 12 hours, and 24 hours. Urine neutrophil gelatinase-associated lipocalin (NGAL) levels were measured as a marker of kidney dysfunction at the following time points: prior to surgery, immediately after surgery, 4 to 6 hours after surgery, and 16-to-18 hours after surgery.Measurements and Main ResultsTwo hundred fifty-two IAPs were measured, and 90 (35.7%) showed IAH. Thirty-five of 42 patients (83.3%) had IAH at 1 time point or more. Peak urine NGAL levels were lower in patients with normal IAP (mean difference = –130.6 ng/mL [95% CI = –211.2 to –50.1], p = 0.002). There was no difference in postoperative kidney dysfunction by risk, injury, failure, loss of kidney function, and end-stage kidney disease (RIFLE) criteria in patients with normal IAP (mean difference = –31.4% [95% CI = –48.0 to 6.3], p = 0.09). IAH was 100% sensitive for predicting postoperative kidney dysfunction by RIFLE criteria, but had poor specificity (54.8%).ConclusionsIAH occurs frequently during the perioperative period in cardiac surgery patients and may be associated with postoperative kidney dysfunction.