术前肺动脉收缩压升高与体外循环心脏手术患者术后发生急性肾损伤及预后有关  

High preoperative pulmonary artery systolic pressure is associated with acute kidney injury and prognosis in patients underwent cardiopulmonary bypass surgery

作　　者：杨艳丽[1] 杨孝磊 任佳悦 马骏[1] Yang Yanli;Yang Xiaolei;Ren Jiayue;Ma Jun(Department of Anesthesiology,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China;Department of Intensive Care Unit,Dongming People's Hospital,Dongming 274500,Shandong,China)

机构地区：[1]首都医科大学附属北京安贞医院麻醉中心,北京100029 [2]东明县人民医院重症监护室,山东东明274500

出　　处：《中华危重病急救医学》2020年第3期319-323,共5页Chinese Critical Care Medicine

基　　金：国家重点研发计划项目(2018YFC2001902);北京市自然科学基金(7192052);北京市医院管理局重点医学专业发展计划项目(ZYLX201810)。

摘　　要：目的:观察肺动脉收缩压(PASP)与体外循环(CPB)心脏手术患者术后发生急性肾损伤(AKI)及预后的关系。方法:检索医院信息系统(HIS)和麦迪斯顿麻醉临床信息系统(DoCare),回顾性分析2015年1月1日至2016年12月31日在北京安贞医院行CPB心脏手术的9860例患者的临床资料。根据术后是否发生AKI分为两组,收集患者的一般资料、手术类型,术前合并症、射血分数、血肌酐(SCr)、PASP,术中CPB时间、主动脉阻断时间、液体平衡情况、血制品和药物使用情况,术后机械通气时间、重症监护病房(ICU)住院时间和住院时间以及围手术期中心静脉压(CVP)等临床资料。采用多因素Logistic回归分析筛选患者术后发生AKI的危险因素。根据术前PASP水平分为≥60 mmHg(1 mmHg=0.133 kPa)组和<60 mmHg组,比较两组患者术后AKI的发生情况及预后。所有患者出院后均进行电话随访,并根据随访结果分为存活组和死亡组,比较两组患者的临床资料,采用多因素Cox回归分析筛选患者远期死亡的危险因素。采用Kaplan-Meier生存曲线分析不同术前PASP水平两组患者远期预后。结果:共6285例患者纳入最终分析。①6285例患者中术后发生AKI 2592例(41.2%),其中改善全球肾脏病预后组织(KDIGO)1期1697例(65.5%),为主要AKI类型。单因素分析显示,年龄,术前射血分数、SCr、PASP及合并冠心病、高血压、糖尿病,术中CPB时间、主动脉阻断时间、液体平衡量、红细胞输入量和去甲肾上腺素、多巴胺、肾上腺素用量,术后机械通气时间、ICU住院时间、住院时间以及围手术期CVP可能是患者术后发生AKI的危险因素。多因素Logistic回归分析显示,术前PASP是CPB心脏手术患者术后发生AKI的独立危险因素之一〔优势比(OR)=4.753,95%可信区间(95%CI)为1.328~8.417,P=0.004〕。PASP≥60 mmHg组术后AKI发生率明显高于<60 mmHg组〔73.8%(712/965)比35.3%(1880/5320),P<0.01〕。②6285例患者随访�Objective To observe the relationship between pulmonary artery systolic pressure(PASP)and acute renal injury(AKI)and prognosis after cardiopulmonary bypass(CPB)heart surgery.Methods The clinical data of 9860 patients who underwent CPB heart surgery in Beijing Anzhen Hospital from January 1st,2015 to December 31st,2016 were analyzed retrospectively.The patients were divided into two groups according to whether AKI occurred after operation.The clinical data were obtained from hospital information system(HIS)and DoCare including general information,types of operation,preoperative complication,ejection fraction,serum creatinine(SCr),PASP,intraoperative CPB duration,aortic occlusion duration,fluid balance,blood products and drug usage,postoperative mechanical ventilation duration,length of intensive care unit(ICU)and hospital stay,and perioperative central venous pressure(CVP).Multivariate Logistic regression analysis was used to screen the risk factors of AKI after operation.According to the preoperative PASP level,the patients were divided into≥60 mmHg(1 mmHg=0.133 kPa)group and<60 mmHg group,and the incidence of AKI and prognosis after operation were compared between the two groups.All patients were followed up by telephone after discharge,and they were divided into survival group and death group according to the follow-up results,and the clinical data were compared between the two groups.Multivariate Cox regression analysis was used to screen the risk factors of long-term prognosis.Kaplan-Meier survival curve was used to analyze the long-term prognosis of two groups with different preoperative PASP levels.Results 6285 patients were enrolled in the final analysis.①Among the 6285 patients,2592 patients(41.2%)suffered from AKI after operation,of whom 1697(65.5%)were stage 1 according to Kidney Disease:Improving Global Outcomes(KDIGO),which was the main type of AKI.Univariate analysis showed that age,preoperative ejection fraction,SCr,PASP,coronary heart disease,hypertension,diabetes,intraoperative CPB duration,ao

关 键 词：肺动脉收缩压 急性肾损伤 预后 

分 类 号：R65[医药卫生—外科学] R614[医药卫生—临床医学]