成人体外循环心脏手术后急性肾损伤的危险因素分析  

Risk factors for acute kidney injury after adult cardiac surgery with cardiopulmonary bypass

作　　者：杨晓梅[1] 王春生[1] 刘岚[1] 张颖[1] 庄亚敏[1] 刘华[1] 高键[2] 

机构地区：[1]复旦大学附属中山医院心外科,上海200032 [2]复旦大学循证医学中心

出　　处：《中华胸心血管外科杂志》2013年第3期147-150,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的探讨成人体外循环心脏手术后急性肾损伤（AKI）的发病情况及危险因素。方法回顾性分析2006年9月至2011年7月行体外循环心脏手术的成人患者6665例。根据术后是否发生AKI分为两组，AKI组1779例，非AKI组4886例。收集患者临床资料，采用单因素和多因素Logistic回归分析AKI发生的危险因素。结果AKI组中102例（1．53％）进行了肾脏替代治疗（RRT），院内死亡44例；非AKI组死亡14例，AKI组住院病死率显著高于非AKI组患者（2．47％对0．29％，P〈0．01）。多因素Logistic回归分析显示，男性、年龄（每增加10岁）、高血压史、糖尿病史、术前基础血肌酐值≥115μmol／L、术前血尿酸值≥420μmol／L、术前左心室射血分数〈0．40、术前贫血、手术类型（主动脉瘤手术）、体外循环≥120min、深低温停循环的应用、术后低血压、术后24h内输血量≥1000ml、术后机械通气≥72h是体外循环心脏术后发生AKI的独立危险因素。结论AKI是成人体外循环心脏手术后的常见并发症，与术后病死率的增加有关。AKI的发生与多种围手术期危险因素有关，应充分重视这些危险因素的评估和预防。Objective To investigate the incidence and risk factors for acute kidney injury （AKI） after adult cardiac surgery with eardlopulmonary bypass. Methods 5665 adult patients who underwent cardiac surgery with cardiopulmonary by- pass in Zhongshan Hospital from September 2006 to July 2011 were analyzed retrospectively. The patients were divided into two groups according to whether AKI occurred after cardiac surgery. We observed the clinical data of the patients in both groups. The risk factors for AKI after operation were evaluated by Univariate analyses and multivariate logistic regression analysis. Results Of the 6665 patients, AKI developed in 1779 （26.69%） patients, whereas 102 （ 1.53% ） had renal replaeement therapy. Patients with AKI had significant higher mortality than patients without AKI （2.47% vs. 0.29% , P 〈0.01 ）. Multi- variate logistic regression analysis revealed that male, increased age, hypertension, diabetes, preoperative serum creatinine （ ≥ 115 μmol/L） , preoperative uric acid（ ≥420 μmol/L） , low preoperative left ventricular ejection fraction（ 〈 0.40） , pre- operative anemia, type of surgery（aortic aneurysm surgery） , long cardiopulmonary bypass time（ ≥120 min） , requirement of deep hypothermic circulatory arrest, postoperative hypotension, blood transfusion within 24 h after operation （ ≥ 1000 ml）, prolonged mechanical ventilation time（≥72 h） were the independent risk factors for AKI in post cardiac surgical patients. Conclusion AKI is a common complication in adult undergoing cardiac surgery with cardiopulmonary bypass, and associated with an increased mortality. The development of AKI is closed related with variety perioperative risk factors, suggesting more at- tention should be paid to the assessment and prevention of these risk factors.

关 键 词：心脏外科手术 体外循环 肾 损伤 危险因素 

分 类 号：R654.2[医药卫生—外科学]