主动脉夹层主动脉弓替换术后肾功能损伤分析  

The renal injury analysis of aortic dissection after aortic arch replacement

作　　者：伍育旗[1] 李玉斌[2] 王清丽[1] 余旻[1] 张立伟[3] 杨晓玲 俞彬[4] 

机构地区：[1]宜昌市第一人民医院重症医学科,湖北省宜昌市443002 [2]宜昌市第一人民医院肾内科,湖北省宜昌市443002 [3]宜昌市第一人民医院胸外科,湖北省宜昌市443002 [4]宜昌市第一人民医院病案室,湖北省宜昌市443002 [5]湖北省当阳市人民医院重症医学科

出　　处：《中国心血管病研究》2015年第10期904-908,共5页Chinese Journal of Cardiovascular Research

摘　　要：目的 分析体外循环下主动脉弓替换术患者肾功能损害的原因及治疗方法.方法 回顾性分析2008年1月至2014年7月宜昌市第一人民医院22例体外循环下主动脉弓替换术的临床资料,其中男性17例、女性5例,年龄（49.53±9.64）岁.结果 术后血肌酐与术前相比有所增高,总体平均值之间的差别具有统计学意义[（174.00±111.61）μmol/L比（87.90±43.44）μmol/L,t=4.137,p=0.000],提为手术加重肾功能损害.体外循环时间≥180 min与体外循环术时间＜180 min相比,肾功能损害的差异有统计学意义（χ^2=3.884,P=0.035）,提示术中长时间体外循环加重肾功能损害.术后肾功能损害与术后无肾功能损害患者相比较,术前肾功能损害是术后肾功能损害的危险因素（χ^2=7.246,P=0.011）.血液净化后血肌酐与血液净化前血肌酐相比有所降低,总体平均值间差别具有统计学意义[（84.00±113.62） μmol/L比（174.00±11 1.00）μmol/L,t=6.335,P=0.000].结论 主动脉夹层主动脉弓替换术后肾功能损伤与体外循环时间过长及术前肾功能损害有关.肾功能损伤患者在重症监护室进行血液净化治疗,疗效满意.Objective To analyze renal injury reason of patients with aortic arch replacement under extracorporeal circulation and give solution. Methods The clinical data of 22 patients with aortic arch replacement were analyzed retrospectively. From 2008 January to 2014 June in Yichang First People＇s Hospital ICU, male 17 cases, female 5 cases, age （49.53±9.64）years old. Results The postoperative serum creatinine was higher than preoperative, the difference was statistically significant [ （174.00±111.61 ）μmol/L vs （87.90±43.44）μmol/L, t= 4.137, P=0.000]. The operation will aggravate renal injury. The renal injury of extracorporeal circulation time≥ 180 min compared with extracorporeal circulation time〈180 min, the difference of renal injury was statistically significant （χ^2=3.884, P=0.035 ）, showed the long time extracorporeal circulation will aggravate renal injury. Preoperative renal injury compared with normal. Preoperative renal injury was the risk factor of postoperative renal failure （χ^2=7.246, P=0.011 ）. The serum creatinine after blood purification was lower than before, the difference was statistically significant [（84.00 ±113.62）μmol/L vs （174.00 ±111.00）μmol/L, t =6.335, P=0.000]. Conclustion The long time extracorporeal circulation and preoperative renal injury are the risk factor of postoperative renal failure. Under CPB aortic arch replacement patients with renal injury receives the satisfactory effect of CRRT in ICU.

关 键 词：重症监护室 深低温循环 主动脉弓替换术 肾功能损伤 

分 类 号：R543.1[医药卫生—心血管疾病]