小儿法洛四联症矫治术后急性肾损伤危险因素分析  

Analysis on risk factors for acute kidney injury after pediatric correction of tetralogy of fallot

作　　者：高婕 崔海丽[2] 孙超[1] 闫玉荣[1] 张全意[1] 晏馥霞[3] GAO-Jie(Department of anesthesiology,affiliated hospital of Binzhou Medical University,Binzhou,Shandong,256603,China)

机构地区：[1]滨州医学院附属医院麻醉科,山东滨州256603 [2]滨州医学院附属医院中心实验室,山东滨州256603 [3]中国医学科学院,北京协和医学院,阜外心血管病医院麻醉科,北京市100037

出　　处：《齐齐哈尔医学院学报》2019年第20期2537-2540,共4页Journal of Qiqihar Medical University

基　　金：滨州医学院科技计划项目(BY2016KJ31)

摘　　要：目的 回顾性分析体外循环下行矫治手术的法洛四联症患儿临床资料,分析法洛四联症矫治术后急性肾损伤(AKI)的围术期危险因素。方法 通过分析我院2016年1月-2018年12月在本院行法洛氏四联症矫治术的908例患儿的临床数据,按照RIFLE标准定义急性肾损伤及损伤的程度,将患儿分为非急性肾损伤组(非AKI组)和急性肾损伤组(AKI组,包括风险期、损伤期、衰竭期),比较两组患儿围术期的各项临床指标,计算法洛四联症患儿完全矫治术后急性肾损伤的发生率,并通过Logistic回归分析找出急性肾损伤的围术期危险因素。结果 共入选826例患儿,其中非AKI组710(86.0%)例,AKI组116(14.0%)例。术后损伤期患儿32例(27.6%),衰竭期14例(12.1%),其中8例(6.9%)患儿术后行透析治疗。多因素Logistic回归分析结果表明患儿术中使用造影剂(OR=2.564,95%CI=1.258-5.229,P=0.010)、术后使用去甲肾上腺素(OR=7.466,95%CI=1.914-29.118,P=0.004)及使用红细胞(OR=1.297,95%CI=1.063~1.581,P=0.010)是小儿法洛四联症矫治术后发生AKI的独立危险因素。结论 法洛四联症矫治术后急性肾损伤的发生率为14.0%,其中处于损伤期和衰竭期的发生率为39.7%。患儿术中使用造影剂、术后使用去甲肾上腺素及使用红细胞是法洛四联症完全矫治术后发生急性肾损伤的独立危险因素。Objective The clinical data of children,received total correction of tetralogy of fallot under extracorporeal circu Iation,was analyzed retrospectively.And analyze the perioperative risk factors of acute kidney injury after pediatric correction of tetralogy of fallot.Methods Clinical data of 908 cases of children,those who underwent correction of tetralogy of fallot in our hospital during January 2016 and December 2018,was analyzed.According to the occurrence of acute kidney injury defined by consensus RIFLE criteria,they were divided into 2 groups,the group of acute kidney injury(AKI group,including Risk,Injury,Failure,)and the group of nonacute kidney injury(none AKI group).The perioperative clinical indexes of the two groups were compared,and calculate the occurrence of AKI in children received correction of tetralogy of fallot.Logistic regression was used to identify the risk factors for acute kidney injury after total correction of tetralogy of Fallot surgery.Results A total of 826 patients were enrolled,of which 710(86.0%)patients in non-acute kidney group and 116(14.0%)patients in acute kidney group.32 patients were in postoperative injury period(27.6%)and 14 were in failure period(12.1%),and 8(6.9%)required dialysis.Multiple logistic regression showed that intraoperative using contrast medium(OR=2.564,95%CI=1.258~5.229,P=0.010),postoperative using norepinephrine(OR=7.466,95%CI=1.914~29.118,P=0.004)and using red blood cells(OR=1.297,95%CI=1.063~1.581,P=0.010)were independent risk factors for acute kidney injury after pediatric correction of tetralogy of Fallot.Conclusions The rate of acute kidney injury after pediatric correction of tetralogy of Fallot is 14.0%,including 39.7%in injury or failure period.Independent risk factors for acute kidney injury in pediatric patients undergoing correction of tetralogy of Fallot are intraoperative using contrast medium,postoperative using norepinephrine and using red blood cells.

关 键 词：法洛四联症 小儿 体外循环 急性肾损伤 

分 类 号：R541[医药卫生—心血管疾病]