急性Stanford A型主动脉夹层患者体外循环术后急性肾损伤的危险因素分析  

Risk factors of acute renal injury after cardiopulm onary bypass in patients with acute Stanford type A aortic dissection

作　　者：苏晶晶[1] 刘宏宇[1] 邓丽[1] 胡光 陈月 张伟[1] 史航[1] 杨慧[1] SU Jing-jing;LIU Hong-yu;DENG Li;HU Guang;CHEN Yue;ZHANG Wei;SHI Hang;YANG Hui(Cardiovascular Surgery, First Affiliated Hospital of Harbin Medical University, Harbin 150000, China)

机构地区：[1]哈尔滨医科大学附属第一医院心脏大血管外科,黑龙江省哈尔滨市150000

出　　处：《中国心血管病研究》2019年第9期793-797,共5页Chinese Journal of Cardiovascular Research

摘　　要：目的探讨急性Stanford A型主动脉夹层患者体外循环术后发生急性肾损伤的相关危险因素。方法回顾性分析2016年7月至2018年12月哈尔滨医科大学附属第一医院心脏大血管外科收治的急性Stanford A型主动脉夹层手术患者的临床资料。根据KDIGO标准分为AKI组及非AKI组,将两组资料进行对比分析,探讨急性Stanford A型主动脉夹层患者术后发生AKI的危险因素。结果共入选患者134例,未发生AKI患者68例(50.7%);发生AKI患者66例(49.3%),其中24例(17.9%)患者需要肾脏替代治疗。AKI组病死率明显高于非AKI组(13.6%比1.5%),AKI组术后ICU停留时间明显长于非AKI组[(13.27±22.87)d比(4.44±3.49)d,P=0.03]。单因素分析结果显示,患者性别、术前血红蛋白以及高血压史、体外循环时间、主动脉阻断时间、术后ICU停留时间、术后气管插管时间及术后病死率差异有统计学意义。Logistic回归分析显示,女性患者(OR=3.943)、高血压史(OR=2.978)、术后气管插管时间(OR=2.969)为急性Stanford A型主动脉夹层患者体外循环术后发生AKI的独立危险因素。结论女性患者、高血压史、术后气管插管时间为急性Stanford A型主动脉夹层患者体外循环术后发生AKI的独立危险因素。Objective To probe the risk factors of acute renal injury after cardiopulmonary bypass in patients with acute Stanford type A aortic dissection. Methods The clinical data of patients with acute Stanford type A aortic dissection admitted to Cardiovascular Surgery Department o f the First Affiliated Hospital of Harbin Medical University from July 2016 to December 2018 were retrospectively analyzed. According to KDIGO standard, the patients were divided into AKI group and non-AKI group. The data of the two groups were compared and analyzed to explore the risk factors of AKJ after acute Stanford A aortic dissection. Results A total of 134 patients were enrolled, 68 of them did not have AKI (5 0 .7 %), 66 o f them (49.3%) had AKI and 24 of them (17.9%) needed renal replacement therapy (CRRT). The mortality rate in AKI group was significantly higher than that in non-AKI group (13.6% vs. 1.5%). Postoperative ICU stay in AKI group was significantly longer than that in non-AKI group[( 13.27±22.87)days vs.(4.44±3.49)days,P=0.03]. Univariate analysis showed significant differences in gender, preoperative hemoglobin, history of hypertension, cardiopulmonary bypass tim e, aortic block time, ICU stay tim e, tracheal intubation time and mortality rate. Logistic regression analysis showed that female patients (OR=3.943), history o f hypertension (OR=2.978) and time o f tracheal intubation (OR=2.969) were independent risk factors for AKI after cardiopulmonary bypass in patients with acute Stanford A aortic dissection. Conclusion Female patients, history of hypertension and time of tracheal intubation are independent risk factors for AKI after cardiopulmonary bypass in patients with acute Stanford A aortic dissection.

关 键 词：急性肾损伤 主动脉夹层 体外循环 危险因素 

分 类 号：R654.2[医药卫生—外科学]