联合瓣膜置换术后急性肾损伤发生的相关危险因素研究  

Retrospective analysis of postoperative acute kidney injury in patients underwent open chest multivalvular replacement surgery

作　　者：张慧 张涛元 王淼 支伟伟 陈伟 Zhang Hui Zhang Tao-yuan Wang Miao Zhi Wei-wei Chen Wei(Department of Anesthesia, the Affiliated Hospital of the Fourth Military Medical University, Xi＇an 710032, China)

机构地区：[1]第四军医大学第一附属医院麻醉科,西安710032 [2]第四军医大学第一附属医院心脏外科,西安710032 [3]西北妇女儿童医院儿外科

出　　处：《中国体外循环杂志》2017年第3期148-152,共5页Chinese Journal of Extracorporeal Circulation

摘　　要：目的研究主动脉瓣+二尖瓣联合瓣膜置换术后急性肾损伤(AKI)的发生情况及其相关危险因素。方法采用回顾性研究。收集本院心外科2011年5月1日至2013年6月30日期间行体外循环下主动脉瓣+二尖瓣联合瓣膜置换术患者400例的临床资料,采用多因素回归方法筛选出该类手术患者术后发生AKI的危险因素。AKI诊断标准为48 h内血清肌酐水平(Scr)上升≥26.4μmol/L,或较基础值增加≥50%,和(或)尿量<0.5 ml/(kg·h)达6 h。结果 400例二尖瓣+主动脉瓣联合瓣膜置换手术患者术后AKI发病率为76%,其中11例(2.75%)需要肾脏替代疗法。单因素分析结果显示年龄、性别、体重指数、术前舒张末容积、基础肾小球滤过率(eGFR)、术前合并高血压、手术时间以及体外循环时间在AKI组和非AKI组具有明显差异。多因素非条件Logistic回归分析表明,年龄增加、男性、体重指数增加、基础eGFR<60 ml/(min·1.73 m^2)以及术前合并高血压是联合瓣膜置换术后AKI的独立危险因素,OR值分别为1.66、2.38、1.15、2.12和2.65。结论 AKI是联合瓣膜置换手术后最常见的严重并发症。高龄、男性、体重指数增加、基础eGFR<60ml/(min·1.73 m^2)以及术前合并高血压是联合瓣膜置换术后发生AKI的独立危险因素。针对AKI及其不良效应的预防和治疗策略是以后研究的重点。Objective To investigate the incidence and risk factors of acute kidney injury （AKI） after open chest multivalvular replacement surgery.Methods 400 patients who received multivalvular （mitral valve plus aortic valve） replacement surgery from May1 st,2011 to June 30 th,2013 in the First Affiliated Hospital of the Fourth Military Medical University were retrospectively analyzed.Multivariate logistic regression analysis was used to determine the risk factors associated with postoperative AKI.AKI was defined according to AKIN as an absolute increment of 26.4 μmol/L in Scr or a relative 50% increment of Scr within 48 hours and/or urine volume 0.5 ml/ （kg·h） up to 6 hours.Results Of all the 400 patients underwent multivalvular （mitral valve plus aortic valve） replacement surgery,the incidence of AKI was 76%,whereas 11 patients （2.75%） needed renal replacement therapy.Univariate analysis of risk factors for the development of AKI in multivalvular replacement surgery demonstrated significant differences in age,gender,body mass index,end-diastolic volume,eGFR,preoperative hypertension,time of surgery and time of cardiopulmonary bypass between AKI group and non-AKI group.In multivariate logistic regression analysis,advanced age,male gender,increased body mass index,preoperative eGFR60 ml/ （min·1.73 m^2） were all identified to be associated with development of AKI independently,and the corresponding OR values were 1.66,2.38,1.15,2.12 and 2.65 respectively.Conclusion AKI is the most common adverse event after multivalvular replacement surgery.Advanced age,male gender,increased body mass index,preoperative eGFR60 ml/ （min·1.73m^2）are independent risk factors of postoperative AKI for patients underwent this procedure.The value of preventative and therapeutic strategies to reduce AKI and theirs effects should be investigated further.

关 键 词：急性肾损伤 联合瓣膜置换术 危险因素 回顾性研究 

分 类 号：R654.2[医药卫生—外科学]