人工心肺の腎機能に与える影響

Anesthesiology 2017; 126:205-13

PMID: 27906706

 Background: Acute kidney injury is a common complication after cardiac surgery with cardiopulmonary bypass. Theauthors evaluated the effects of normothermic cardiopulmonary bypass on renal blood flow, glomerular filtration rate, renal

oxygen consumption, and renal oxygen supply/demand relationship, i.e., renal oxygenation (primary outcome) in patients

undergoing cardiac surgery.

Methods: Eighteen patients with a normal preoperative serum creatinine undergoing cardiac surgery procedures with normothermic

cardiopulmonary bypass (2.5 l . min−1 . m−2) were included after informed consent. Systemic and renal hemodynamic

variables were measured by pulmonary artery and renal vein catheters before, during, and after cardiopulmonary bypass. Arterial

and renal vein blood samples were taken for measurements of renal oxygen delivery and consumption. Renal oxygenation

was estimated from the renal oxygen extraction. Urinary N-acetyl-β-d-glucosaminidase was measured before, during, and after

cardiopulmonary bypass.

Results: Cardiopulmonary bypass induced a renal vasoconstriction and redistribution of blood flow away from the kidneys,

which in combination with hemodilution decreased renal oxygen delivery by 20%, while glomerular filtration rate

and renal oxygen consumption were unchanged. Thus, renal oxygen extraction increased by 39 to 45%, indicating a renal

oxygen supply/demand mismatch during cardiopulmonary bypass. After weaning from cardiopulmonary bypass, renal

oxygenation was further impaired due to hemodilution and an increase in renal oxygen consumption, accompanied by a

seven-fold increase in the urinary N-acetyl-β-d-glucosaminidase/creatinine ratio.

Conclusions: Cardiopulmonary bypass impairs renal oxygenation due to renal vasoconstriction and hemodilution during

and after cardiopulmonary bypass, accompanied by increased release of a tubular injury marker.

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