急性A型主动脉夹层术后肾衰竭的危险因素分析  

Acute renal failure following operation in patients with acute type A aortic dissection:an analysis of risk factors

作　　者：王树伟[1] 苏存华[2] 阎岩[1] 陆乘俊 韩林[1] 徐志云[1] 

机构地区：[1]第二军医大学长海医院胸心外科,上海200433 [2]南京市第一医院心胸外科,南京210006

出　　处：《第二军医大学学报》2014年第2期136-140,共5页Academic Journal of Second Military Medical University

基　　金：上海市科委重点基础项目(12JC1408102)~~

摘　　要：目的 探讨急性A型主动脉夹层术后急性肾衰竭（acute renal failure,ARF）的危险因素.方法 回顾性分析2002年1月至2013年3月间接受手术的266例急性A型主动脉夹层患者资料,根据患者术后是否发生ARF分为ARF组和无ARF组,比较两组间一般临床特征间的差异,并采用多因素条件logistic回归方法分析术后ARF的独立危险因素.结果 18例（6.77％）患者术后发生ARF.两组患者在术前心功能不全（NYHAⅢ～Ⅳ级,P=0.024）、肾功能不全（P=0.002）、术中体外循环时间≥190 min（P=0.000）、主动脉阻断时间≥90 min（P=0.015）及术后二次开胸止血（P=0.004）、脑损伤（P=0.013）和急性呼吸功能障碍（P=0.000）的人数分布差异有统计学意义.ARF组患者的体外循环时间、主动脉阻断时间和围术期红细胞输注量高于无ARF组,差异有统计学意义（P均＜0.05）.多因素条件logistic回归分析显示术前肾功能不全（OR=6.978,95％ CI为1.874～25.997）、体外循环时间≥190 min（OR=5.663,95％ CI为1.621～19.781）、围术期大量输注红细胞（OR=1.071,95％ CI为1.030～1.113）和术后急性呼吸功能障碍（OR=4.853,95％ CI为1.467～16.053）是术后ARF发生的独立危险因素.结论 ARF是多种因素共同作用导致的严重并发症.术后早期应严密观察患者病情变化,及时进行ARF评估并个体化干预,以减少住院死亡率并改善预后.Objective To identify the risk factors of acute renal failure following operation in patients with acute type A aortic dissection （AAAD）. Methods The clinical data of 266 consecutive patients undergoing operation for AAAD between Jan. 2002 and Mar. 2013 were retrospectively analyzed. The patients were divided into two groups according to the presence of postoperative acute renal failure. The general data were compared between the two groups. Univariate and multivariate conditional logistic regression analysis were used to determine the independent risk factors of postoperative acute renal failure. Results Eighteen （6.77G） patients had acute renal failure in our study. The incidence rates of preoperative cardiac dysfunction （NYHA Ⅲ Ⅳ） （P=0. 024）, renal insufficiency （P=0. 002） , cardiopulmonary bypass time （CPBT） ≥190 min （P=0. 000）, aortic cross clamp tirne≥90 min （P = 0. 015）, postoperative re operation for bleeding （P=0. 004）, brain damage （P=0. 013）, acute respiratory dysfunction （P=0. 000） and perioperative erythrocyte transfusions （P=0. 015） were significantly different between the two groups preoperatively. Multivariate conditional logistic regression analysis showed that preoperative renal insufficiency （OR=6. 978, 95G CI： 1. 874 25. 997）, CPBT≥190 rain （OR=5. 663, 95% CI： 1. 621 19. 781）, perioperative erythrocyte transfusions （OR=1. 071, 95% CI： 1. 030 1. 113）and postoperative acute respiratory dysfunction （OR=4. 853, 95 % CI： 1. 467 16. 053）were independent risk factors for postoperative acute renal failure. Conclttsion Renal failure is a severecomplication caused by many risk factors after operation in AAAD patients. The patients should be monitored closely early after operation; the risks of acute renal failure should be assessed and individualized intervention should be given to improve hospital mortality and prognosis.

关 键 词：胸主动脉 夹层动脉瘤 急性肾衰竭 危险因素 

分 类 号：R654.31[医药卫生—外科学]