术后低白蛋白血症是体外循环心脏手术后急性肾损伤的独立危险因素  

Postoperative hypoalbuminemia is an independent risk factor for acute kidney injury after cardiac surgery under cardiopulmonary bypass

作　　者：梁淑芳 周静文[2] 林倩[1] 史应龙[2] 周红卫[2] 刘福岗 谢恺庆[1] Liang Shufang;Zhou Jingwen;Lin Qian;Shi Yinglong;Zhou Hongwei;Liu Fugang;Xie Kaiqing(Department of Blood Purification,the Second Affiliated Hospital of Guangxi Medical University,Nanning 530007,China;Department of Blood Purification,the First Affiliated Hospital of Guangxi Medical University,Nanning 530021,China;Department of Nephrology,Hezhou People's Hospital,Hezhou 542899,China)

机构地区：[1]广西医科大学第二附属医院血液净化部,南宁530007 [2]广西医科大学第一附属医院血液净化部,南宁530021 [3]贺州市人民医院肾内科,贺州542899

出　　处：《中华肾脏病杂志》2020年第8期618-624,共7页Chinese Journal of Nephrology

基　　金：广西自然科学基金(2018GXNSFAA050057)。

摘　　要：目的探究术后低白蛋白血症对心肺转流术(cardiopulmonary bypass,CPB)体外循环心脏手术后急性肾损伤(AKI)的影响。方法回顾性分析行CPB心脏手术的成年患者临床资料,比较术前和术后血清白蛋白水平。按术后48 h内的最低血清白蛋白浓度分为低白蛋白血症组(≤35 g/L)和非低白蛋白血症组(>35 g/L),比较两组患者术后AKI的发生率及严重程度,采用二分类Logistic回归分析评价术后低白蛋白血症对CPB心脏手术后AKI的影响。结果在纳入的749例患者中,与术前相比,术后血清白蛋白水平明显下降(Z=-15.739,P<0.001),低白蛋白血症患者比例升高(27.6%比9.6%,χ^2=83.516,P<0.001)。CPB术后有273例患者发生AKI,其中低白蛋白血症组109例(52.7%),非低白蛋白血症组164例(30.3%)。低白蛋白血症组AKI发生率高于非低白蛋白血症组,差异有统计学意义(χ^2=32.443,P<0.001),且低白蛋白血症组发生AKI的严重程度较非低白蛋白血症组增加(Z=-2.098,P=0.036),住院时间延长(Z=-2.442,P=0.015)。经校正性别、年龄、术前低白蛋白血症、伴发疾病(高血压、高尿酸血症、糖尿病、脑血管疾病)、基础肾功能不全、术前心功能水平、行冠状动脉造影术、CPB时间、主动脉夹闭时间、心脏手术类型、术后低血压等影响因素后,二分类Logistic回归分析显示术后低白蛋白血症是CPB术后AKI的独立危险因素(OR=2.319,95%CI 1.586~3.392,P<0.001)。结论AKI是CPB心脏手术后常见并发症。CPB心脏手术后血清白蛋白较术前下降,术后48 h内低白蛋白血症是AKI发生的独立危险因素。Objective To investigate the effect of postoperative hypoalbuminemia on acute kidney injury(AKI)after cardiac surgery under cardiopulmonary bypass(CPB).Methods The clinical data of adult patients undergoing cardiac surgery under CPB were retrospectively analyzed.The difference between preoperative and postoperative serum albumin level was compared.The patients were divided into hypoalbuminemia group(≤35 g/L)and non-hypoalbuminemia group(>35 g/L)according to the lowest serum albumin concentration within 48 hours after surgery.The incidence and severity of postoperative AKI were compared between the two groups.Univariate analysis and binary logistic regression analysis were used to evaluate the effect of postoperative hypoalbuminemia on the incidence of postoperative AKI.Results Among the 749 patients,the serum albumin level after cardiac surgery was significantly lower than that before surgery(Z=-15.739,P<0.001),and the proportion of patients with hypoalbuminemia increased from 9.6%to 27.6%(χ^2=83.516,P<0.001).Postoperative AKI occurred in 273 patients,including 109 cases(52.7%)in hypoalbuminemia group and 164 cases(30.3%)in non-hypoalbuminemia group.The incidence of AKI in hypoalbuminemia group was significantly higher than that in non-hypoalbuminemia group(χ^2=32.443,P<0.001),and the severity of AKI in hypoalbuminemia group increased than that in non-hypoalbuminemia group(Z=-2.098,P=0.036),and the time of hospital stay extended(Z=-2.442,P=0.015).After adjusted by gender,age,preoperative hypoalbuminemia,comorbidities(hypertension,hyperuricemia,diabetes mellitus,cerebrovascular disease),renal insufficiency,preoperative heart function,coronary angiography,CPB time,aorta blocking time,type of heart surgery and postoperative hypotension,binary logistic regression analysis revealed that postoperative hypoalbuminemia was an independent risk factor for CPB-associated AKI(OR=2.319,95%CI 1.586-3.392,P<0.001).Conclusions AKI is a common complication following cardiac surgery under CPB.Serum albumin after CBP is signifi

关 键 词：低白蛋白血症 急性肾损伤 危险因素 心脏外科手术 

分 类 号：R654.2[医药卫生—外科学]