心脏手术后急性肾损伤远期预后的研究  

A long-term outcome study of acute kidney injury after cardiac surgery

作　　者：姜俊[1] 丁小强[1] 姜物华[1] 许佳瑞[1] 方艺[1] 滕杰[1] 

机构地区：[1]复旦大学附属中山医院肾内科,上海200032

出　　处：《中华内科杂志》2014年第12期947-952,共6页Chinese Journal of Internal Medicine

基　　金：“十二五”国家科技支撑计划（2011BAI10B07）

摘　　要：目的 探讨心脏手术后急性肾损伤（AKI）患者的远期预后及肾脏转归.方法 选2009年4月至2011年2月复旦大学附属中山医院行心脏外科手术治疗的患者,术后依据改善全球肾脏病预后组织（KDIGO）推荐指南的AKI诊断标准分为AKI组与非AKI组,随访2年,记录2年累积生存率及晚期慢性肾脏病（CKD）（4～5期）发病率,分析患者术后2年累积生存率及进展至晚期CKD的影响因素.结果 共纳入1 770例心脏术后患者,其中715例患者发生术后AKI,发病率为40.4％.（1）2年累积生存率AKI组（83.2％）低于非AKI组（93.6％;P＜0.05）;与非AKI组比,AKI显著增加患者的死亡风险（RR=1.710,95％ CI1.250 ～2.340）;多因素Cox回归分析显示：AKI是独立的增加死亡风险的因素,风险强度仅次于糖尿病和慢性心功能不全,高龄、术前合并有慢性心功能不全、糖尿病史、ICU留治时间也显著增加患者的死亡风险.（2）术后2年晚期CKD的发病率AKI组（6.7％）高于非AKI组（0.2％;P＜0.05）;与非AKI组比,AKI组发生晚期CKD的RR=31.220,95％ CI7.550 ～ 129.110;多因素Cox回归分析显示：校正其他因素影响,AKI仍是独立的增加晚期CKD发病风险的因素,而术前合并糖尿病史、术中心肺旁路时间、ICU留治时间也会增加晚期CKD的发病风险.结论 心脏术后AKI显著增加患者术后2年的死亡风险,并显著增加术后2年晚期CKD的发病率.重视心脏手术后AKI的防治,出院后肾功能的随访与保护,以改善患者的远期预后.Objective To evaluate the long-term outcome of acute kidney injury （AKI） during hospitalization after cardiac surgery.Methods 1 770 patients underwent cardiac surgery in Fudan University Zhongshan Hospital from April 2009 to February 2011 were enrolled.Based on the Kidney Disease：Improving Global Outcomes （KDIGO） guideline of AKI,the patients were divided into the AKI and the nonAKI groups,and followed up for 2 years.The 2-year survival rate and incidence of the advanced chronic kidney disease （CKD） was compared between the two groups.Factors influencing the 2-year survival rate and incidence of the advanced CKD were also analyzed.Results Among all the patients,715 （40.4％） of them were developed AKT.（1） The 2-year survival rate of the AKI group was lower than that of the non-AKI group （83.2％ vs 93.6％ ;P ＜0.05）.Compared with the non-AKI group,AKI group had an increased risk for death with the hazard ratio of 1.710 （95％ CI 1.250-2.340）.COX regression analysis showed that AKI was an independent factor for death with the risk intensity just less than diabetes and chronic cardiac insufficiency.The advanced age,the preoperative history of chronic cardiac insufficiency and the time of staying in ICU also significantly increased the risk of death.（2） Compared with patients without AKI （0.2 ％）,the incidence of the 2-year of advanced CKD was higher in patients with AKI （6.7 ％ ; P ＜ 0.05） with an hazard ratio of 31.220 （95 ％ CI 7.550-129.110）.COX regression analysis showed that AKI was still the independent risk factor for advanced CKD after adjustment of other factors.In addition,diabetes,the time of the cardiopulmonary bypass and the time of staying in ICU were also associated with the risk for the advanced CKD.Conclusions AKI is common after cardiac surgery,which was associated with a decrease in the 2-year survival rate and an increase in the incidence of advanced CKD of patients,which emphasized the importance of prevention and treatment of AKI,and close f

关 键 词：急性肾损伤 心脏病 心脏外科手术 远期预后 慢性肾脏病 

分 类 号：R654.2[医药卫生—外科学]