肾动脉受累:急性Stanford A型主动脉夹层中低温停循环术后急性肾损伤KDIGO 3期的独立危险因素  

Renal artery involvement:independent risk factors of KDIGO stage 3 in acute renal injury after moderate hypothermic circulatory arrest in acute Stanford type A aortic dissection

作　　者：葛翼鹏[1] 里程楠[1] 钟永亮[1] 夏瑀[1] 肖付诚 胡海瓯[1] 郑铁[1] 朱俊明[1] 孙立忠[1] Ge Yipeng;Li Chengnan;Zhong Yonglang;Xia Yu;Xiao Fucheng;Hu Hai'ou;Zheng Tie;Zhu Junming;Sun Lizhong(Department of Cardiovascular Surgery,Beijing Aortic Disease Center,Beijing Anzhen Hospital Capital Medical University 100029)

机构地区：[1]首都医科大学附属北京安贞医院心血管外科,100029

出　　处：《中华胸心血管外科杂志》2021年第6期335-338,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：北京市医院管理中心青苗计划专项(QML20190608);北京市科委-首都临床诊疗技术研究及示范应用(Z19110700660000);国家自然科学基金(81970393);北京市科技重大专项课题(Z171100001017083)。

摘　　要：目的探讨肾动脉受累是否是急性Stanford A型主动脉夹层中低温停循环术后急性肾损伤(acute kidney injury,AKI)KDIGO 3期的独立危险因素。方法2015年12月至2017年10月,连续492例急性Stanford A型主动脉夹层患者接受外科手术治疗,其中486例纳入研究。所有患者接受主动脉CTA检查明确主动脉夹层病变范围以及肾动脉是否受累。依据改善全球肾脏病预后组织(Kidney Disease:Improving Global Outcomes,KDIGO)标准对患者术后肾功能进行分期。将患者术后出现AKI KDIGO 3期作为因变量,进行危险因素分析。肾动脉受累以及其他危险因素先纳入单因素分析,单因素分析有意义的变量纳入多因素logistic回归分析。结果492例患者中院内死40例(8.13%),其中6例因术中严重出血死或者不能脱离体外循环机未出手术室无法计算AKI分期,因而未纳入研究。纳入研究的486例患者中有251例(51.64%)出现AKI。其中KDIGO 1期83例(17.08%),2期56例(11.52%),3期112例(23.05%)。单因素分析结果显示,术前肾动脉受累、年龄、发病至手术时间、外周血D-二聚体、白细胞数量及血小板数量、肌酐清除率、术中体外循环时间、主动脉阻断时间有统计学意义(P>0.05)。将以上因素纳入多因素logistic回归,结果显示,术前肾动脉受累(OR=1.94,P=0.02)、年龄(OR=1.03,P=0.02)、血肌酐清除率<85 ml/min(OR=2.28,P=0.001)以及术中体外循环时间(OR=1.01,P=0.02)为独立危险因素。肾动脉受累组患者AKI发生率54.65%,显著高于肾动脉未受累组41.98%(P>0.05)。结论肾动脉受累是急性Stanford A型主动脉夹层深低温停循环术后AKI KDIGO 3期的独立危险因素,术后AKI发生率显著增加。Objective To explore whether renal artery involvement is an independent risk factor of acute renal injury(AKI)KDIGO stage 3 after moderate hypothermic circulatory arrest in patients with acute Stanford type A aortic dissection.Methods From December 2015 to October 2017,492 consecutive patients with acute Stanford A-type aortic dissection received surgical treatment,486 of them were included in the study.All patients underwent aortic CTA to determine the extent of aortic dissection and renal artery involvement.According to the standard of Improving Global Outcomes(KDIGO),the renal function of patients after operation was graded.The risk factors of AKI KDIGO stage 3 were analyzed.Renal artery involvement and other risk factors were included in univariate analysis,and significant variables in univariate analysis were included in multivariate logistic regression analysis.Results In 492 patients,40(8.13%)died in hospital,of which 6 died of severe bleeding during operation or failed to wean from cardiopulmonary bypass which lead to unable to leave the Weaning from cardiopulmonary bypass and these 6 patients were excluded in the research.Among 486 patients included in the study,251(51.64%)had AKI.Among them,83(17.08%)were in the KDIGO stage 1,56(11.52%)in stage 2 and 112(23.05%)in stage 3.The results of univariate analysis showed that there were significant differences in renal artery involvement,age,time from onset to operation,D-dimer,leukocytes and platelets in peripheral blood,creatinine clearance rate,time of cardiopulmonary bypass during operation and aortic cross-clamping time(P>0.05).The above risk factors were included in multivariate logistic regression.The results showed that preoperative renal artery involvement(OR=1.94,P=0.02),age(OR=1.03,P=0.02),creatinine clearance rate<85 ml/min(OR=2.28,P=0.001),and intraoperative cardiopulmonary bypass time(OR=1.01,P=0.02)were independent risk factors.The incidence of AKI in patients with renal artery involvement was 54.65%,significantly higher than 41.98%in patients wi

关 键 词：急性Stanford A型主动脉夹层 肾动脉受累 急性肾损伤 

分 类 号：R654.3[医药卫生—外科学]