中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

急性 Stanford A 型主动脉夹层术后急性肾功能损伤的危险因素分析

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目的 分析急性 Stanford A 型主动脉夹层术后急性肾功能损伤的危险因素。 方法 回顾性分析青岛市市立医院 2010 年 9 月至 2017 年 9 月间 220 例 Stanford A 型主动脉夹层手术患者的资料。平均年龄(52.3±8.7)岁,男 162 例(73.6%),女 58 例(26.4%)。按患者术后是否发生急性肾功能损伤(AKI)分 2 组,发生 AKI 者 40 例(A 组),其中男 29 例、女 11 例,平均年龄(54.6±9.2)岁。未发生 AKI 者 180 例(B 组),男 133 例、女 47 例,平均年龄(48.5±7.9)岁。对两组患者围术期多项指标进行单因素和多因素分析。 结果 住院死亡 12 例(5.5%),发生 AKI 组患者死亡 7 例(17.5%),未发生 AKI 组患者死亡 5 例(2.8%)。单因素分析显示,两组患者年龄、术前血清肌酐值、术前白细胞水平、欧洲心血管手术危险因素评分、体外循环时间、深低温停循环(DHCA)时间、主动脉根部处理、主动脉弓置换、术中及术后 24 h 输注红细胞量、术后机械通气时间、ICU 滞留时间、住院时间、院内死亡率等方面差异有统计学意义。多因素分析显示,术前血清肌酐值、术前白细胞水平、体外循环时间和术中及术后 24 h 输注红细胞量是术后 AKI 的独立危险因素。 结论 术前血清肌酐值、术前白细胞水平、体外循环时间和术中及术后 24 h 输注红细胞量是急性 Stanford A 型主动脉夹层术后急性肾功能损伤的独立危险因素。临床上可以根据上述危险因素采取相应的预防措施,保护肾脏功能,减少围术期死亡率。

Objective To identify the predictors of postoperative acute kidney injury in patients undergoing surgery for acute aortic dissection type A. Methods A total of 220 patients who underwent surgery for acute aortic dissection type A in Qingdao Municipal Hospital from September 2010 to September 2017 were divided into two groups including a group A and a group B based on whether acute kidney injury occurred or not after surgery. There were 40 patients with 29 males and 11 females with the mean age of 54.6±9.2 years in the group A, 180 patients with 133 males and 47 females with the mean age of 48.5±7.9 years in the group B. Univariate and multivariate analysis (logistic regression) were used to identify the predictive risk factors. Results Overall in-hospital mortality was 5.5%.In univariate analyses, there was statistically significant differences with respect to the age, preoperative creatinine, preoperative white blood cell, the European system for cardiac operative risk evaluation (EuroSCORE), total cardiopulmonary bypass (CPB) time, deep hypothermic circulatory arrest (DHCA), arch replacement, red blood cell transfusion intraoperative and in 24 hours postoperatively, postoperative mechanical ventilation time, ICU stay duration, hospital stay duration and in- hospital mortality. Multivariate logistic analysis showed that preoperative creatinine, preoperative white blood cell, CPB time, and red blood cell transfusion intraoperative and in 24 hours postoperatively were the independent predictors for postoperative acute kidney injury. Conclusion The incidence of acute kidney injury is high after surgery for acute aortic dissection type A. It can be predicted based on above factors, for patients with these risk factors, more perioperative care strategies are needed in order to induce the incidence of acute kidney injury.

关键词: 主动脉夹层; 肾功能损伤; 危险因素

Key words: Acute aortic dissection; acute kidney injury; risk factors

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