急性Stanford A型主动脉夹层患者术后并发急性肾损伤的相关因素研究  

The risk factors analysis for postoperative acute kidney injury in Stanford type A acute aortic dissection patients

作　　者：郭拓 柴湘平[1] 周阳 杨贵芳[1] 彭文[1] 贺华平 潘小高 GUO Tuo;CHAI Xiangping;ZHOU Yang;YANG Guifang;PENG Wen;HE Huaping;PAN Xiaogao(Department of Emergency,the Second Xiangya Hospital of Central South University,Changsha Hunan 410011,China)

机构地区：[1]中南大学湘雅二医院急诊医学科,湖南长沙410011

出　　处：《中国急救复苏与灾害医学杂志》2021年第5期536-539,544,共5页China Journal of Emergency Resuscitation and Disaster Medicine

摘　　要：目的了解急性Stanford A型主动脉夹层(stanford type a acute aortic dissection,TAAD)患者术后并发急性肾损伤(acute kidney injury,AKI)的相关因素.方法回顾性收集中南大学湘雅二医院2017年1月—12月接受外科手术治疗的急性Stanford A型主动脉夹层患者的病例资料.根据患者术后是否发生AKI,分为AKI组和非AKI组.对两组患者的一般情况、实验室检查、手术时间、手术方式、体外循环相关因素等指标进行比较,并通过多因素回归分析术后急性肾损伤的危险因素,最后绘制受试者工作特征曲线(operating characteristic curve,ROC)评估其预测价值.结果共有126例患者纳入研究,平均年龄(50.1±10.8)岁,其中AKI组共61例,非AKI组共65例.单因素分析显示,两组患者的年龄、术前血清肌酐(Scr)、体外循环时间和夹层累及肾动脉比例的差异具有统计学意义(P<0.05).多因素分析显示,术前Scr水平(OR=1.015,95%CI:1.004~1.027)、体外循环时间(OR=1.004,95%CI:1.000~1.007)和肾动脉受累(OR=2.324,95%CI:1.043~5.179)是术后并发急性肾损伤的独立危险因素.ROC曲线分析显示,术前Scr水平、体外循环时间和肾动脉受累对于术后急性肾损伤的发生均有着一定的预测价值,ROC曲线下面积(area under curve,AUC)分别为0.630、0.630和0.599.结论术前Scr水平、体外循环时间和夹层累及肾动脉是术后并发急性肾损伤的独立危险因素.Objectives To evaluate the risk factors of postoperative acute kidney injury(AKI)in Stanford type A acute aortic dissection(TAAD)patients.Methods From January 2017 to December 2017,126 cases of TAAD hospitalized patients were collected retrospectively in the Second Xiangya Hospital of Central South University.Patients were divided into AKI group and non-AKI group.The general characteristics,laboratory results,operation time,surgical approaches and cardiovascular bypass indexs between the two groups were compared.Univariate and multivariate analysis were utilized to identify the independent risk factors of postoperative AKI.Receiver operating characteristic curve(ROC)was drawn to evaluate the predictive value of these risk factors.Results A totall of 127 patients were enrolled with the mean age of 50.1±10.8 years.In the AKI group,there were 61 patients,while in the non-AKI group,65 patients were included.The Univariate logistic regression analysis revealed that the age,preoperative serum creatinine,cardiopulmonary bypass time and renal artery involvement had statistical significant differences.Multivariate analysis found that preoperative serum creatinine(OR=1.015,95%:1.004〜1.027),cardiopulmonary bypass time(OR=1.004,95%CI:1.000-1.007)and renal artery involvement(OR=2.324,95%CI:1.043-5.179)were independent risk factors to postoperative AKI.Finally,ROC curve anlysis found that the predictive values in postoperative AKI were 0.630,0.630 and 0.599,respectively.Conclusion The preoperative serum creatinine,cardiopulmonary bypass time and renal artery involvement were identified to be independent predictors for postoperative AKI in patients with TAAD.

关 键 词：急性Stanford A型主动脉夹层 急性肾损伤 相关因素 

分 类 号：R692[医药卫生—泌尿科学]