全胸腹主动脉置换术后急性肾衰竭病因分析及预测  

Analysis and prediction of acute kidney injury after total thoracic and abdominal aortic replacement

作　　者：王嵘[1] 周晨阳[1] 朱俊明[1] 孙立忠[1] WANG Rong;ZHOU Chenyang;JIANG Wenjian;ZHU Junming(Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所心脏外科北京市心肺血管疾病研究所北京大血管疾病诊疗中心北京市大血管外科植入式人工材料工程技术研究中心

出　　处：《心肺血管病杂志》2019年第6期640-643,共4页Journal of Cardiovascular and Pulmonary Diseases

基　　金：国家自然科学基金(81800404,81470580);北京市优秀人才培养资助青年骨干个人项目(2017000021469G254);首都卫生发展科研专项项目—青年优才(2018-4-2068);北京市科技重大专项课题(Z171100001017083);国家科技支撑计划项目(2015BAI12B03);心血管疾病精准医学北京实验室(PXM2017_014226_000037);北京市医院管理局青年人才培养“青苗”计划(QML20180601)

摘　　要：目的:胸腹主动脉瘤置换术后急性肾衰竭作为发生率最高的严重并发症之一,对患者的生活质量及生存时间影响极大。通过分析寻求对胸腹主动脉瘤置换术后急性肾衰竭发生的预测。方法:回顾性收集北京安贞医院主动脉外科,2014年至2015年共计48例常温阻断应用4分支人工血管行全胸腹主置换术患者围术期数据。应用Logistic回归模型进行病因分析并进行模型调优,并应用五折法交叉验证确定模型准确性。结果:48例非体外循环常温阻断下行全胸腹主动脉置换术的患者,平均年龄为(37.64±10.54)岁,其中7(13.2%)例为女性。13(27.1%)例为马方综合征患者。有11(20.8%)例患者使用了连续性肾脏替代治疗(CRRT)。右肾动脉阻断时间增加(P=0.041),年龄的增加(P=0.052),性别为男性(P=0.032),术后首次乳酸指标(LAC)较高(P<0.001),以及输注RBC过多(P=0.053)会增加术后急性肾衰竭发生,而BMI较高(P=0.004)则为急性肾衰竭发生的保护因素。结论:全胸腹主动脉置换术右肾动脉阻断时间增加,年龄的增加,性别为男性,术后首次LAC指标较高,以及输注红细胞过多会增加术后急性肾衰竭发生率,BMI较高则为急性肾衰竭发生的保护因素。Logistic回归模型可以较好的早期预测全胸腹主动脉置换术后肾衰竭的发生。可根据预测结果早期对可能出现肾衰竭的患者进行CRRT治疗,让患者肾脏得到充分的休息。Objective: Acute renal injury after thoracoabdominal aortic aneurysm repair(TAAAR) is one of the most serious complications, which has a great impact on patients′ quality of life and survival time. We seek to predict the occurrence of acute kidney injury after TAAAR. Methods: Perioperative data of TAAAR were retrospectively collected from Beijing Anzhen Hospital. Logistic regression model was used to analyze the factors and optimize the model, and the accuracy of the model was determined by five-fold cross validation method. Results: From 2014 to 2015, 48 TAAARs were performed. The average age was(37.64±10.54), of which 7(13.2%) were female. 13(27.1%) patients were patients with Marfan syndrome. 11(20.8%) patients used CRRT. Prolonged right renal artery blocking time, senility, male, upraised LAC after operation, and transfused more RBC will increase the incidence of postoperative acute renal failure, whereas higher BMI was the protective factor. Conclusions: Prolonged right renal artery blocking time, senility, male, upraised LAC after operation, and transfused more RBC will increase the incidence of postoperative acute renal failure, whereas higher BMI was the protective factor. Logistic regression model can predict the occurrence of renal failure after total thoracic and abdominal aortic replacement. According to the prediction result, patients with renal failure may be treated with CRRT in the early stage.

关 键 词：胸腹主动脉瘤置换术 急性肾衰竭 预测 

分 类 号：R54[医药卫生—心血管疾病]