心脏瓣膜置换术后急性肾衰竭的高危因素分析  

Risk factor analysis for dialyzed acute renal failure patients underwent valve replacement surgery

作　　者：赵铁夫[1] 王盛宇[1] 阎晓蕾[2] 马涵英[3] 

机构地区：[1]首都医科大学附属北京安贞医院心脏外科,100029 [2]首都医科大学附属北京安贞医院重症医学科,100029 [3]首都医科大学附属北京安贞医院老年心内科,100029

出　　处：《北京医学》2013年第10期834-837,共4页Beijing Medical Journal

摘　　要：目的探讨心脏瓣膜置换术后发生需透析治疗的急性肾衰竭(ARF)的高危因素。方法回顾性分析2005-2010年97例心脏瓣膜置换术后发生ARF且需要透析治疗患者的危险因素,应用logistic回归进行多因素分析,筛选出高危因素。结果心脏瓣膜置换术后发生需透析治疗的ARF的高危因素包括术后低心排出量综合征、术后24 h内大量输入库存血、体外循环时间、术前心功能(NYHA分级)、术前血肌酐水平,其中术后低心排出量综合征与ARF发生的关系最为密切。结论重视围手期患者的处理,改善术前心功能、注意术中心肌保护、缩短体外循环时间,加强术后监护等可减少ARF的发生,降低病死率。Objective To investigate the high risk factors for dialysis dependant acute renal failure（ARF） after valve replacement surgery.Methods A total of 97 cases who developed dialysis dependant ARF after valve replacement surgery from 2005 to 2010 were enrolled in this study.And multivariate logistic regression was established to analyze the high risk factors related to dialysis dependant ARF.Results Multivariate logistic regression revealed that the high risk factors were postoperative low cardiac output syndrome,receiving a great amount of banked blood transfusion in 24 hours after operation,duration of cardiopulmonary bypass,preoperative heart function（NYHA） and serum creatinine level.Conclusion More attention should be paid for perioperative managements of patients,such as preoperative medication on improving cardiac function,professional operative skills,improvement of myocardial protective measures and advanced postoperative monitoring.The elimination of risk factors attributing to ARF could possibly lead to lower perioperative mortality.

关 键 词：瓣膜置换术 急性肾衰竭 

分 类 号：R654.2[医药卫生—外科学]