心脏手术相关性急性肾损伤发病率及其危险因素分析  

Incidence and risk factors of cardiac surgery-associated acute kidney injury

作　　者：万辛[1] 陈鑫[2] 谢祥成[1,3] 嵇小兵[1] 曹长春[1] 

机构地区：[1]南京医科大学附属南京医院肾内科,江苏南京210006 [2]南京医科大学附属南京医院胸心血管外科,江苏南京210006 [3]杭州市第一人民医院肾内科,浙江杭州310000

出　　处：《南京医科大学学报（自然科学版）》2015年第12期1746-1749,共4页Journal of Nanjing Medical University(Natural Sciences)

基　　金：江苏省临床医学科技专项资助(BL2014015);南京市科技发展计划(201405031)

摘　　要：目的 :应用KDIGO标准,评估心脏手术相关性急性肾损伤(cardiac surgery-associated acute kidney injury,CSA-AKI)的发病率及其相关危险因素。方法:回顾性分析南京医科大学附属南京医院2009年1月—2011年12月在体外循环(cardiopulmonary bypass,CPB)下进行心脏手术的1 575例患者的临床特征。采用单因素和多因素logistic回归分析CSA-AKI发生的影响因素。多元Cox比例风险模型评估CSA-AKI对ICU期间病死率和住院期间病死率的影响。结果:1 575例患者中,534例(34%)发生CSA-AKI,22例(1.4%)患者需要肾替代治疗,住院总病死率为1.3%(20/1 575)。CSA-AKI的独立危险因素为机械通气时间(P<0.001)、CPB时间≥100 min(P<0.01)、输注红细胞(P<0.001)、术后3 d内体温超过38℃(P<0.05)等,而使用乌司他丁与CSA-AKI低发生率相关(P<0.01)。Cox比例风险模型结果显示AKI住院期间死亡风险是非AKI患者的2.26倍(P<0.05),而需要肾脏替代治疗患者其死亡风险是非肾脏替代患者的18.65倍(P<0.001)。结论:CSA-AKI的发生与机械通气时间、输注红细胞以及术后3 d内体温超过38°C等密切相关。乌司他丁的使用与CSA-AKI低发病率有关。CSA-AKI与住院期间死亡风险显著相关,尤其是接受肾替代治疗的患者。Objective：To investigate the incidence and related risk factors of cardiac surgery-associated acute kidney injury（CASAKI）. Methods：A retrospective analysis of 1 575 patients undergoing cardiac surgery with cardiopulmonary bypass（CPB）between January 2009 and December 2011 in Nanjing First Hospital,was recruited. Univariate and multiple logistic regression models were employed for determining the association between the development of CSA-AKI and risk factors. Multiple Cox-proportional hazards modeling was used to evaluate the impact of CSA-AKI on the mortality of ICU and hospital length of stay. Results：Among this cohort,of 1 575 patients,534（34%）occurred AKI. A total of 22（1.4%）patients required renal replacement therapy. The overall inhospital mortality rate was 1.3%（20 of 1575）. Logistic regression analysis showed that mechanical ventilation duration（P〈0.001）CPB duration of ≥100 min（P〈0.01）erythrocytes transfusion（P〈0.001）and postoperative body temperature greater than 38℃within 3 days（P〈0.05）were found to be independent risk factors of CSA-AKI,while ulinastatin use was associated with lower incidence for CSA-AKI（P〈0.05）. CSA-AKI was significantly related to high in-hospital mortality（P〈0.05）especially in patients requiring RRT（P〈0.001）. Conclusion：The incidence of CSA-AKI in patients form this cohort was 34%. Mechanical ventilation duration,erythrocytes transfusion and postoperative body temperature greater than 38°C within 3 days were independent risk factors of CSA-AKI. Ulinastatin was associated with lower incidence of CSA-AKI.

关 键 词：心脏手术相关的急性肾损伤 发病率 危险因素 

分 类 号：R692[医药卫生—泌尿科学]