A型主动脉夹层术后急性肾损伤并行肾脏替代治疗患者的预后因素分析  

Prognosis factors in patients with acute kidney injury after type A aortic dissection surgery undergone renal replacement therapy

作　　者：黄浩[1] 汪薇[1] 柳林伟[1] 王宏飞[2] 

机构地区：[1]湖北省天门市第一人民医院肾内科,天门431700 [2]华中科技大学同济医学院附属协和医院心血管外科,武汉430030

出　　处：《中国循证心血管医学杂志》2016年第1期103-106,共4页Chinese Journal of Evidence-Based Cardiovascular Medicine

摘　　要：目的回顾性分析2007年6月-2015年3月在我院就诊的96例A型主动脉夹层术后急性肾损伤并行肾脏替代治疗患者的临床资料,进而探讨影响其预后的危险因素。方法按照临床结局将纳入的患者分为生存组（56例）和死亡组（40例）,比较两组患者术前、术中和术后资料,并行多元素Logistic回归分析评估影响该人群预后的独立危险因素。结果通过比较两组患者的资料,发现死亡组术前心功能Ⅳ级、神经系统障碍、肝功能不全、术后低血压、消化道出血发生率和APACHEⅡ评分均较高,差异具有统计学意义（P〈0.05）。多因素Logistic回归分析表明术前心功能Ⅳ级、术后肝功能不全、术后低血压和APACHEⅡ评分是患者死亡的独立危险因素（P〈0.05）。结论 A型主动脉夹层术后急性肾损伤并行肾脏替代治疗患者的预后与术后肝功能不全、术后低血压、APACHEⅡ评分和术前心功能Ⅳ级有关,因此,应重视患者围手术期的危险因素并加以干预,以改善患者的预后情况。Objective To analyze retrospectively the clinical materials of patients with acute kidney injury（AKI） after type A aortic dissection surgery undergone renal replacement therapy（RRT）, and discuss the risk factors influencing prognosis. Methods The patients（n=96） were chosen from Jun. 2007 to Mar. 2015, and then divided, according to their clinical outcomes, into survival group（n=56） and death group（n=40）. The clinical materials were compared between 2 groups before, during and after the operation. The independent risk factors influencing prognosis were reviewed by using multivariate Logistic regression analysis. Results The comparison in materials of 2 groups showed that incidence rates of NYHA functional class IV, neurological disorders and hepatic insufficiency before the operation, and hypotension, gastrointestinal bleeding, APACHE II scores after the operation were higher in death group（P〈0.05）. The results of multivariate Logistic regression analysis showed that NYHA functional class IV before the operation, and hepatic insufficiency, hypotension and APACHE II scores after the operation were independent risk factors of death（P〈0.05）. Conclusion The prognosis is related to hepatic insufficiency, hypotension and APACHE II scores after the operation and NYHA functional class IV before the operation in patients with AKI after type A aortic dissection surgery undergone RRT. The perioperative risk factors should be paid more attention to and given intervention for improving patient＇s prognosis.

关 键 词：主动脉夹层 急性肾损伤 肾脏替代治疗 危险因素 

分 类 号：R543.1[医药卫生—心血管疾病]