目的:探讨紫绀型先天性心脏病(cyanosis congenital heart disease，C-CHD))和非紫绀型先天性心脏病(acyanosis congenital heart disease，A-CHD)体外循环心脏手术后肾损伤的情况及可能的影响因素。方法:回顾性收集2017年7月1日至2019年9月30日上海交通大学医学院附属新华医院PICU收治并完成体外循环心脏手术的患儿103例，分为C-CHD组(n n＝36)和A-CHD组(n n＝67)，分别记录并比较两组患儿的一般资料，手术相关资料，术后入PICU时、术后24 h、术后48 h的血流动力学和氧代谢指标，以及术中与术后血管活性药物应用情况和液体出入量；计算两组急性肾损伤(AKI)发生率及分期。采用多因素Logistic回归分析术后48 h的血流动力学和氧代谢指标与AKI的关系，建立相对应的模型，采用受试者工作特征曲线(ROC)分析血流动力学和氧代谢指标对心脏术后AKI的预测价值。n 结果:103例患儿中，男62例，女41例，中位年龄7(4，24)个月，术前C-CHD组Hb、Hct高于A-CHD组(n P<0.05)。和A-CHD组相比，C-CHD组患儿的美国麻醉医师协会分级、先天性心脏病手术风险分级评估分级更高，手术时间、体外循环时间更长，术中应用血管活性药物剂量更大(n P<0.05)。C-CHD组术后入PICU时、术后24 h、术后48 h的中心静脉压均高于A-CHD组，且在术后应用血管活性药物剂量更大(n P<0.05)；而与C-CHD组相比，A-CHD组血乳酸更低，PaOn 2更高(n P0.05)。将术后48 h的血流动力学和氧代谢指标纳入回归分析并建立相应模型，结果发现PaOn 2和SaOn 2是术后AKI发生的独立危险因素(n P<0.05)，而大循环指标不能直接反映肾灌注情况。血流动力学指标和氧代谢指标联合应用对预测AKI的价值更高(ROC曲线下面积0.897，95%n CI 0.836～0.957)。n 结论:与A-CHD患儿相比，C-CHD患儿对手术造成的肾损害耐受程度更高，对于术后的氧耗需求更低，液体负荷相对较高。评估其心脏术后血流动力学和氧代谢指标变化对防治肾损伤具有重要的临床意义。“,”Objective:To investigate the acute kidney injury(AKI) after cardiopulmonary bypass surgery for cyanotic congenital heart diseases(C-CHD) as well as and acyanotic congenital heart diseases(A-CHD)and its possible influencing factors.Methods:One hundred and three patients with CHD admitted to PICU of Xinhua Hospital Affiliated to Shanghai Jiaotong University were enrolled from July 1, 2017 to September 30, 2019.The patients were divided into C-CHD group(n n=36)and A-CHD group(n n=67). The preoperative general data and information related to the operation of two groups were recorded.Hemodynamic data, oxygen metabolism index, dose of vasoactive drugs during or after operation and liquid equilibrium were assessed after surgery.The incidence and stage of AKI were calculated.Multivariate Logistic regression was used to analyze the relationship between hemodynamic index and oxygen metabolism index and AKI.The predictive value of hemodynamics and oxygen metabolism for AKI after cardiac surgery was analyzed by receiver operating characteristic curve (ROC).n Results:A total of one hundred and three patients were enrolled including sixty-two males and forty-one females, the median age was 7(4, 24) months old.The preoperative hemoglobin and hematocrit in the C-CHD group were higher than those in the A-CHD group(n P<0.05). Compared with the A-CHD group, the C-CHD group had higher American Society of Anesthesiologists Grades and Risk Adjustment for Congenital Heart Surgery Grades, longer operation time and cardiopulmonary bypass time(n P<0.05). Central venous pressure in C-CHD group was higher than that in A-CHD group, and C-CHD group had higher dose of vasoactive drugs after surgery(n P<0.05). Compared with the C-CHD group, blood lactic acid was lower and arterial oxygen partial pressure was higher in the A-CHD group(n P0.05). Multivariate Logistic regression analysis showed that partial arterial oxygen pressure and arterial oxygen satiety were independent risk factors for AKI(n P<0.05). The large circulation index could not directly reflect the renal perfusion.Compared with using hemodynamic index or oxygen metabolism index alone to predict the occurrence of AKI 48 h after the operation, the combined application of the two methods had higher predictive value for AKI.n Conclusion:Compared with patient with A-CHD, patients with C-CHD have higher tolerance to renal damage caused by surgery, and the kidney of patient with C-CHD have higher tolerance to postoperative fluid load and demand lower oxygen consumption.It is of great clinical significance to evaluate the changes of hemodynamics and oxygen metabolism after cardiac surgery for the prevention and treatment of renal injury.