心脏移植术后急性肾损伤的危险因素  

Risk factors for postoperative acute kidney injury in patients undergoing cardiac transplantation

作　　者：周飞[1] 王月兰[1] 

机构地区：[1]山东大学附属千佛山医院麻醉科,济南市250014

出　　处：《中华麻醉学杂志》2015年第7期784-786,共3页Chinese Journal of Anesthesiology

摘　　要：目的筛选心脏移植术后急性肾损伤的危险因素。方法选择术前肾功能未见异常的接受心脏移植术的终末期心脏疾病患者40例，性别不限，年龄13～66岁，体重45～84kg，ASA分级Ⅳ或V级，NYHA心功能分级Ⅲ或Ⅳ级。根据术后7d内是否发生急性肾损伤，将患者分为急性肾损伤组和非急性肾损伤组。收集患者年龄、性别、体重、并存疾病情况（高血压和糖尿病）、术前血糖、血红蛋白、血肌酐、心输出量、射血分数和肺动脉收缩压、术中体外循环（CPB）时间和红细胞输注量、术后24h尿量等。将组间比较差异有统计学意义的因素进行多因素logistic回归分析，筛选该类患者术后急性肾损伤的危险因素。结果共纳入39例患者，其中14例发生急性肾损伤，其发生率为36％。logistic回归分析结果显示：术前并存肺动脉高压和CPB时间〉180min是心脏移植术后急性肾损伤的独立危险因素（P〈0．05）。结论术前并存肺动脉高压和CPB时间〉180rain是心脏移植术后急性肾损伤的独立危险因素。Objective To determine the risk factors for postoperative acute kidney injury （AKI） in the patients undergoing cardiac transplantation. Methods Forty patients with end-stage heart failure （both sexes） , aged 13-66 yr, weighing 45-84 kg, of ASA physical status Ⅳ or Ⅴ （NYHA Ⅲ or Ⅳ） , undergoing heart transplantation, with normal kidney function before operation, were selected. According to whether or not AKI occurred within 7 days after operation, the patients were divided into either AKI group or non-AKl group. Factors including age, gender, body weight, complications （including hypertension and diabetes mellitus） , preoperative blood glucose, hemoglobin, serum creatinine, cardiac output, ejection fraction, pulmonary arterial systolic pressure, intraoperative cardiopulmonary bypass （CPB） time, transfusion of allogeneic red blood cells, and urine volume within 24 h after operation were recorded. The risk factors of which P values were less than 0.05 would enter the multivariate logistic regression analysis to stratify postoperative AKI-related risk factors for this type of patients. Results A total of 39 patients were enrolled in this study. Of the 39 patients, 14 patients suffered from AKI after operation, and the incidence was 36%. The results of logistic regression analysis showed that preoperative pulmonary hypertension and CPB time 〉 180 min were the independent risk factors for AKI after cardiac transplantation. Conclusion Preoperative pulmonary hypertension and CPB time〉 180 min are the independent risk factors for postoperative AKI in the patients undergoing cardiac transplantation.

关 键 词：心脏移植 危险因素 急性肾损伤 

分 类 号：R614[医药卫生—麻醉学]