老年心脏外科术后急性肾损伤患者长期预后分析  

Long-term prognosis of elderly patients with acute kidney injury after cardiac surgery

作　　者：沈波[1] 陈楠[2] 庄亚敏[3] 滕杰[1] 姜俊[1] 吕文律[1] 刘中华[1] 邹建洲[1] 钟一红[1] 王春生[3] 丁小强[1] 

机构地区：[1]复旦大学附属中山医院肾科,上海市200032 [2]复旦大学附属上海市公共卫生临床中心肝病中心,上海市201508 [3]复旦大学附属中山医院心脏外科,上海市200032

出　　处：《实用老年医学》2013年第11期890-893,共4页Practical Geriatrics

基　　金：国家十二五支撑计划课题(2011BAI10B07);科技部国家科技支撑计划(2011BAJ18B03)

摘　　要：目的了解老年心脏外科术后急性肾损伤(AKI)患者的长期预后。方法回顾性分析2009年1月至2011年1月期间,在复旦大学附属中山医院心脏外科接受手术后发生(AKI)的老年患者。根据患者术后是否发生AKI分为AKI组和非AKI组,随访术后2年患者肾功能及生存情况,比较2组生存率及晚期慢性肾脏病发病率差别。结果共393例患者纳入研究,其中AKI患者214例(1期148例、2期34例、3期32例),占55.4%。AKI组患者年龄大于非AKI组[(71.1±4.6)岁比(69.9±4.3)岁,P<0.01],AKI组男性比例显著高于非AKI组(71.9%比55.9%,P<0.01);AKI患者1年累积生存率为78.0%,显著低于非AKI组(P<0.01)。AKI 1~3期患者术后1年累积生存率分别为85.8%、64.7%、62.5%,2年累积生存率期分别为79.1%、46.9%、55.9%,差异具有统计学意义(P<0.01);AKI患者术后2年累积晚期慢性肾脏病患病率显著高于非AKI组(7.9%比0.0%,P<0.01),AKI 1~3期患者术后2年晚期慢性肾脏病患病率分别为4.1%、8.8%和25.0%(P<0.01)。结论老年心脏手术患者是术后AKI发病高危人群。AKI患者远期累积生存率和肾脏功能恢复程度均低于非AKI患者,且随AKI严重程度加重而变化。老年患者心脏手术后AKI的防治策略需要进一步研究,以改善其长期预后。Objective To analyse the long-term prognosis of acute kidney injury( AKI) in elderly patients after cardiac surgery. Methods A retrospective study of elderly patients with AKI after cardiac surgery from January 2009 to January 2011 was carried out. Patients were divided into AKI group and non-AKI group and followed up for 2 years. The survival rate and the incidence of advanced chronic kidney disease were analysed. Results 393 patients were enrolled and 214( 55. 4%) were patients with AKI( 148 cases of AKI-1,34 cases of AKI-2 and 32 cases of AKI-3). The patients in AKI group were significantly older than those in non-AKI group( 71. 1 ± 4. 6 vs 69. 9 ± 4. 3,P < 0. 01),and the proportion of male in AKI group was significantly higher than that in non-AKI group( 71. 9% vs 55. 9%,P < 0. 01); 1 year cumulative survival in AKI was 78. 0%,which was significantly lower than non-AKI group( P < 0. 01). One year cumulative survival rate of AKI-1 to AKI-3 was 85. 8%,64. 7%,62. 5%,and two-years cumulative survival rate of AKI-1 to AKI-3 was 79. 1%, 46. 9% and 55. 9%( P < 0. 01); The incidence of advanced CKD in AKI patients after two-year follow up was significantly higher than that in non-AKI group( 7. 9% vs 0. 0%,P < 0. 01). Then the incidence of advanced CKD in AKI-1 to AKI-3 patients after 2 years was 4. 1%,8. 8% and 25. 0%( P < 0. 01). Conclusions The elderly patients after cardiac surgery were at high risk of AKI. The incidence and severity of AKI were associated with the long-term survival and renal recovery.

关 键 词：急性肾损伤 老年人 心脏外科手术 预后 

分 类 号：R692.5[医药卫生—泌尿科学] R654.2[医药卫生—外科学]