Stanford A型主动脉夹层患者术前肾功能及影响因素分析  

Changes of preoperative renal function in patients with Stanford type A aortic dissection and its influencing factors

作　　者：杜宇奎[1] 庞秀慧[2] 买买提艾力.艾则孜 张立[4] 何亮[4] 阿依别克.乃比 郭盛[3] 刘筠[3] 张总刚[3] 杨秀滨[1] 唐和年[3] 

机构地区：[1]北京协和医学院中国医学科学院阜外心血管病医院外科,北京100037 [2]新疆维吾尔自治区人民医院临床检验中心,乌鲁木齐830001 [3]新疆维吾尔自治区人民医院心外科,乌鲁木齐830001 [4]新疆维吾尔自治区人民医院麻醉科,乌鲁木齐830001

出　　处：《中华实用诊断与治疗杂志》2015年第10期1014-1015,1018,共3页Journal of Chinese Practical Diagnosis and Therapy

摘　　要：目的探讨Stanford A型主动脉夹层术前肾功能及其影响因素。方法 Stanford A型主动脉夹层157例(夹层组)按发病时间分为急性期91例、亚急性期41例和慢性期25例,同期体检健康者95例为对照组。检测并比较对照组和夹层组患者术前血清尿素氮(blood urea nitrogen,BUN)、肌酐(serum creatinine,SCr)、尿酸(uric acid,UA)水平;全主动脉CT血管造影测定夹层原发破口、剥离范围;心脏彩超评估主动脉瓣反流情况。结果夹层组术前BUN[6.63(4.89,8.36)mmol/L]、SCr[(112.23±95.69)μmol/L]高于对照组[5.48(4.55,6.24)mmol/L,(70.35±13.19)μmol/L](P<0.01),UA[(339.93±135.34)μmol/L]与对照组[(313.04±88.52)μmol/L]比较差异无统计学意义(P>0.05);Stanford A型主动脉夹层急性期组UA[(372.06±122.82)μmol/L]高于亚急性期组[(286.23±124.34)μmol/L](P<0.01),与慢性期组[(316.37±166.85)μmol/L]比较差异无统计学意义(P>0.05);Pearson相关分析显示UA与主动脉夹层分期(r=-0.220,P=0.010)、性别(r=-0.180,P=0.030)呈负相关,与左肾动脉开口情况呈正相关(r=0.280,P=0.010)。结论 Stanford A型主动脉夹层患者术前肾功能受损明显,血清BUN、SCr水平不受主动脉夹层基线资料和解剖特征影响。Objective To investigate the changes of preoperative renal function and its influencing factor in Stanford type A aortic dissection （AD）. Methods A total of 157 patients with Stanford type A AD （AD group） were divided into 3 subgroups based on disease course, acute stage group （n= 91）, subacute stage group （n= 41） and chronic stage group （n=25）. Another 95 healthy volunteers were as controls （control group）. The levels of blood urea nitrogen （BUN）, serum creatinine （SCr） and uric acid （UA） were detected and compared among groups. The primary entry tear and extent of AD were measured by CT angiography. The degree of aortic valve insufficiency was measured by CT angiography. Results The preoperative levels of BUN （6. 63 （4. 89,8. 36） mmol/L） and SCr （（112. 23 ± 95. 69） μmol/L） were significantly higher in AD group than those in control group （ 5.48 （4.55,6.24） mmol/L, （70.35 ± 13.19） μmol/L） （P〈 0.01）, and there was no significant difference in UA level between AD group （（339.93± 135.34） μmol/L） and control group （（313.04±88. 52）μmol/L） （P〉0.05）. UA level was significantly higher in acute stage group （（372. 06±122.82）μmol/L） than that in subacute stage group （（286.23± 124.34） μmol/L） （P〈0.01）, and had no significant difference in comparison with that in chronic stage group （316.37± 166.85） μmol/L） （P〉0.05）. Pearson showed UA level was negatively correlated with the stage of AD （r=0.220, P=0.010） and patients gender （r=0. 180, P= 0. 030）, and positively with the conditions of the left renal artery opening （r =0. 280, P=0. 010）. Conclusion The renal function is obviously damaged before operation in patients with Stanford type A AD. The levels of BUN and SCr are not influenced by AD baseline data and anatomical characteristics.

关 键 词：主动脉夹层 肾功能 STANFORD A型 

分 类 号：R654.3[医药卫生—外科学]