Stanford A型主动脉夹层术后急性肾损伤行肾脏替代治疗患者的预后  

Prognosis of acute kidney injury requiring renal replacement therapy in patients undergoing surgery for Stanford type A aortic dissection

作　　者：杨晓梅[1] 刘岚[1] 庄亚敏[1] 张颖[1] 刘华[1] 高键[2] 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 [2]复旦大学循证医学中心

出　　处：《中华胸心血管外科杂志》2014年第6期346-349,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：国家“十二”五科技支撑计划（2011BAI11B20）

摘　　要：目的探讨StanfordA型主动脉夹层手术后发生急性肾损伤并行肾脏替代治疗患者的预后及死亡危险因素。方法回顾并分析2005年10月至2013年5月68例StanfordA型主动脉夹层手术后行肾脏替代治疗的患者资料，男53例，女15例；年龄（53．31±11．08）岁。按照临床结局分为生存组（40例）和死亡组（28例）。单因素分析患者的术前、术中、术后的临床资料，再行多元逐步Cox回归分析死亡的独立危险因素。结果68例患者中，死亡28例，占41．18％。单因素分析发现，APACHE Ⅱ评分、术后发生低血压、消化道出血、肝功能不全和神经系统功能障碍所占比例两组的差异有统计学意义（P〈0．05）。多元逐步Cox回归分析发现，心功能Ⅳ级（HR5．486，95％C11．805～16．676）、APACHEII评分（HR1．123，95％CI1．055～1．196）、术后低血压（HR3．328，95％CI1．180～9．382）、术后肝功能不全（HR2．242，95％CI1．015～4．952）是术后死亡的独立危险因素。结论StanfordA型主动脉夹层术后急性肾损伤行肾脏替代治疗患者的死亡比例较高，充分重视患者的围手术期死亡危险因素，尽早干预，可能有利于改善预后。Objective Acute kidney injury（AKI） is a common and serious complication with high morbidity and mor- tality in patients undergoing surgery for Stanford type A aortic dissection. The purpose of this study is to investigate the mortality and risk factors for the prognosis of AKI requiring renal replacement therapy（RRT） in patients undergoing surgery for Stanford type A aortic dissection. Methods We retrospectively investigated 68 patients of AKI requiring RRT undergoing surgery for Stanford type A aortic dissection in Zhongshan Hospital from October 2005 to May 2013. The mean age was （55.31 _＋ 11.08 ） years. The patients were divided into two groups, survivors （n = 40） and non-survivors（ n = 28 ）. We observed the clinical data of the patients in both groups. Univariate and multivariate analyses were performed to investigate the risk factors for prognosis of AKI requiring RRT. Results Of the 68 patients, 28 patients died. The in-hospital mortality was 41.18%. Univariate analysis showed the following as significant risk factors： APACHE II score, hypotension, gastrointestinal bleeding, hepatic dysfunction, neurological deficits（ P 〈 0.05 ）. Muhivariable Cox regression analysis identified New York Heart Association （NYHA） func- tional class 1V（HR 5.486,95% CI 1. 805 - 16. 676） ,APACHE II seore（HR 1. 123,95% CI 1. 055 - 1. 196） , hypotension （HR 3. 328,95% C1 1. 180 -9. 382） ,hepatic dysfunetion（HR 2. 242,95% CI 1. 015 -4. 952） were independent predictors of in-hospital mortality（P 〈 0.05 ）. Conclusion AKI requiring RRT after Stanford type A aortic dissection surgery is associated with high mortality. Risk factors of death should be taken into consideration for perioperative care and may improve clinical outcome.

关 键 词：动脉瘤 夹层 肾功能不全 急性 肾替代疗法 预后 

分 类 号：R654.3[医药卫生—外科学]