老年患者心脏手术后急性肾损伤的流行病学调查  

Epidemiological investigation of acute kidney injury after cardiac surgery in elderly patients

作　　者：滕杰[1] 许佳瑞[1] 方艺[1] 徐少伟[1] 沈波[1] 刘中华[1] 邹建洲[1] 晋玮[1] 刘红[1] 许嵘[1] 衡艳艳[1] 崔晓萌[1] 王春生[2] 杨守国[2] 刘岚[2] 丁小强[1] 

机构地区：[1]复旦大学附属中山医院肾脏内科,上海200032 [2]复旦大学附属中山医院心脏外科,上海200032

出　　处：《上海医学》2012年第9期760-764,共5页Shanghai Medical Journal

基　　金：教育部"211"重大项目(211XK60);上海市医学发展基金重点课题(2003ZD001);国家十二五支撑计划课题(2011BAI10B07)资助项目

摘　　要：目的了解中国老年人心脏手术后急性肾损伤(AKI)的发病现状,以指导研究进一步的防治措施。方法前瞻性收集接受心脏外科手术治疗且年龄≥65岁的住院患者的病史资料,分析老年患者心脏手术类型构成、术后AKI发病率、发病危险因素及短期预后。结果共纳入810例老年心脏手术患者,男498例、女312例,年龄65～87岁,平均年龄为(71±5)岁。手术类型以冠状动脉旁路移植术(CABG,44.0%)、心脏瓣膜手术(38.0%)和CABG联合瓣膜手术(10.4%)为主。术后AKI发病率为52.3%(424/810),接受肾脏替代治疗(RRT)的危重AKI发病率为3.2%(26/810)。总院内病死率为3.6%(29/810),AKI患者的院内病死率为6.4%,显著高于非AKI患者的0.5%(P<0.01)。心脏移植术后的AKI发病率最高,其次为先天性心脏病纠治联合瓣膜术、主动脉瘤手术;CABG联合瓣膜术后的院内病死率最高,其次为主动脉瘤手术和CABG。Logistic多因素回归分析显示,男性(OR=2.02,95%CI为1.35～3.01,P=0.001)、术前肾功能减退(血清肌酐水平>106μmol/L,OR=4.63,95%CI为2.01～10.67,P<0.001)、术中心肺旁路时间(OR=1.01,95%CI为1.01～1.02,P<0.001)、术后低血压且因低血压使用缩血管药物(OR=2.48,95%CI为1.18～5.21,P=0.002)为老年人心脏手术后AKI发病的危险因素。结论老年患者心脏手术后AKI发病率高、预后较差,手术类型以CABG多见,心脏移植术、先天性心脏病纠治联合瓣膜术、主动脉瘤手术为术后AKI发病的高危术式。Objective To study the kidney injury （AKI） after cardiac surgery in elderly patients and investigate the prophylaxis and treatment. Methods We prospectively collected the clinical data from the patients who were above 65 years old and underwent cardiac surgery. Types of surgery, incidence of AKI, risk factors, and short-term prognosis were recorded. Results Totally 810 elderly patients were enrolled in this study. There were 498 males and 312 females with an average age of （71 ± 5） years （ranged from 65 to 87 years）. Coronary artery bypass graft （CABG） was the most frequently applied （44.0%） method, followed by valve surgery （38.0%） and CABG combined with valve surgery （10.4%）. The overall incidence of AKI was 52.3% （424/810）. The incidence of AKI requiring renal replacement treatment （AKI-RRT） was 3.2% （26/810）. The overall hospital mortality was 3.6% （29/810）. The hospital mortality in AKI patients was significantly higher than that in the non-AKI patients （6. 4% vs. 0. 5%, P ~ 0. 01）. AKI incidence was highest in cardiac transplantation （ 100.0 % ）, followed by congenital heart disease operation combined with valve surgery （85.7 % ） and aorta surgery （77.8%）. The hospital mortality was highest in CABG combined with valve surgery （7.2 % ）,followed by aorta surgery （5.6 % ） and CABG （3.4%）. Multivariate logistic regression analysis showed that male sex （ OR = 2.02, 95 % CI 1.35 - 3.01, P = 0.001 ）, preoperative renal dysfunction （serum creatinine〉 106 μmol/L, OR = 4.63, 95 % CI 2.01 - 10.67, P〈0.001 ）, intraoperative cardiopulmonary bypass time （ OR = 1.01, 95 % CI 1.01 - 1.02, P〈0.001 ）, and postoperative administration of vasopressors for hypotension （OR = 2.48, 95 % Cl 1.18-5.21, P=0. 002） were the risk factors of AKI after cardiac surgery in elderly patients. Conclusion AKI incidence and hospital mortality after cardiac surgery in elderly patients are very high, and CABG is the most common operation in our hospita

关 键 词：心脏手术 老年人 急性肾损伤 预后 危险因素 

分 类 号：R654.2[医药卫生—外科学]