A型主动脉夹层术后肾功能衰竭危险因素分析  

Analysis of the risk factors of postoperative renal failure of type A aortic dissection

作　　者：罗海燕[1] 胡克俭[1] 刘祖赟[1] 程玥[1] 赵赟[1] 潘荪[1] 赵强[1] 王春生[1] 

机构地区：[1]复旦大学附属中山医院心外科,上海200032

出　　处：《中华外科杂志》2008年第14期1070-1072,共3页Chinese Journal of Surgery

基　　金：上海市重点学科建设资助项目（B116）

摘　　要：目的分析深低温停循环（DHCA）结合脑灌注下A型主动脉夹层术后肾功能衰竭（RF）的相关危险因素，并探讨肾脏保护措施。方法2004年1月至2007年10月157例患者在DHCA结合脑灌注下行A型主动脉夹层手术，男性115例，女性42例；年龄17—76岁。129例采用腋动脉插管选择性脑灌注，28例采用上腔静脉逆行性脑灌注。对所有术前、术中相关因素行单因素及多因素分析。结果平均心肺转流时间（188．0±10．8）min，脑灌注时间（36．0±3．1）min。住院死亡15例（9．6％），永久性神经功能障碍8例（5．1％），术后RF20例（12．8％）。多因素分析示，术前肾功能不全和年龄〉70岁是术后RF发生的相关危险因素。术后RF患者其住院死亡率（45％，P=0．001）和永久性神经功能障碍的发生率（25％，P=0．009）远高于其他患者。结论高龄及术前肾功能不全是A型主动脉夹层术后RF发生的高危因素。Objective To evaluate the risk factors of postoperative renal failure （RF） in the patients with type A dissection of aorta operated on with cerebral perfusion and deep hypothermia circulatory arrest （DHCA）. Methods From January 2004 to October 2007, 157 patients with type A dissection of aorta underwent surgical procedures with cerebral perfusion and DHCA. There were 115 male patients and 42 female patients with the age from 17 to 76 years old. Antegrade selective cerebral perfusion through axillary artery was performed for 129 patients and retrograde cerebral perfusion from superior cava vein was performed for 28 patients. All the factors underwent univariate and multivariate analysiss. Results Mean cardiopulmonary bypass duration was （188.0 ± 10. 8 ） min and mean cerebral perfusion time was （36.0± 3.1 ） min. Fifteen patients died in hospital and the hospital mortality was 9. 6%. Permanent neurological dysfunction （PND） occurred in 8 patients （5.1%）. Postoperative RF was observed in 20 patients （ 12. 8% ）. Multivariate analysis showed the preoperative renal dysfunction （ P = 0. 042, OR = 4.41 ） and over seventy-year-old patients （ P = 0. 049, OR =4.94 ） were found to be the risk factors of postoperative RF. There was a higher incidence of death （45%, P =0. 001 ） and PND（25% , P =0. 009） in the patients of postoperative RF when compared with the other patients. Conclusion The preoperative renal dysfunction and elderly patients were found to be the risk factors of postoperative RF after type A dissection of aorta surgery.

关 键 词：主动脉瘤 胸 肾功能衰竭 危险因素 

分 类 号：R654.3[医药卫生—外科学] R692.5[医药卫生—临床医学]