心肺转流下心脏瓣膜术后急性肾损伤的危险因素分析  

Risk factors for perioperative acute kidney injury in adult cardiac valve surgery with cardiopulmonary bypass

作　　者：傅之梅[1,2] 严敏[1] 郁丽娜[1] 张冯江[1] 周振锋[1] 孙凯[1] 

机构地区：[1]浙江大学医学院附属第二医院麻醉科,杭州市310009 [2]浙江省立同德医院麻醉科

出　　处：《临床麻醉学杂志》2017年第6期534-537,共4页Journal of Clinical Anesthesiology

摘　　要：目的探讨成人心肺转流(cardiopulmonary bypass,CPB)下心脏瓣膜手术后急性肾损伤(acute kidney injury,AKI)的危险因素。方法回顾性分析1 349例心脏瓣膜手术患者的临床资料,采用多因素Logistic回归分析心脏瓣膜术后AKI的危险因素。结果 1 349例心脏瓣膜手术患者AKI发生率为28.4%,多因素Logistic回归分析显示,每增加1岁(OR=1.05,95%CI 1.03~1.06,P<0.001)、糖尿病史(OR=2.11,95%CI 1.22~3.68,P=0.008)、贫血(OR=1.50,95%CI1.05~2.21,P=0.026)、术前血清肌酐(Scr)值每增加1mg/dl(OR=1.01,95%CI 1.01~1.02,P=0.001)、手术时间每增加1h(OR=1.28,95%CI 1.15~1.41,P<0.001)、术中输注血浆(OR=1.50,95%CI 1.14~1.97,P=0.004)是心脏瓣膜术后发生AKI的独立危险因素。结论心肺转流下心脏瓣膜术后急性肾损伤的独立危险因素是高龄、糖尿病史、贫血、术前肌酐高、手术时间长以及术中输注血浆。Objective To investigate the risk factors of acute kidney injury（AKI）in patients undergoing cardiac valve surgery with cardiopulmonary bypass（CPB）.Methods A retrospective cohort database study was conducted,involving 1 349 patients undergoing heart valve surgery with CPB technique.Logistic regression was used to screen out the risk factors of AKI after the surgery.Results Of the 1 349 patients,the incidence of AKI in valve surgery was 28.4%.One year older（OR=1.05,95%CI 1.03-1.06,P 0.001）,diabetes（OR =2.11,95%CI 1.22-3.68,P =0.008）,anemia（OR=1.50,95%CI 1.05-2.21,P=0.026）,each additional basic serum creatinine of 1mg/dl（OR=1.01,95%CI 1.01-1.02,P=0.001）,each additional operation time of 1hour（OR=1.28,95%CI 1.15-1.41,P〈0.001）,plasma transfusion during surgery（OR=1.50,95%CI 1.14-1.97,P =0.004）were the independent risk factors for AKI in multivariate logistic regression model.Conclusion AKI is a common and serious complication following cardiac valve surgery.More attention should be paid to the patients with elder age,anemia,prolonged operation time,diabetes,increased basic serum creatinine and requirement of plasma transfusion during surgery.

关 键 词：心脏瓣膜手术 心肺转流 急性肾损伤 危险因素 

分 类 号：R614[医药卫生—麻醉学]