老年患者心脏瓣膜置换术后急性肾衰竭透析治疗的高危因素分析  

Analysis of High Risk Factors of Dialysis Treatment for Elderly Patients with Acute Renal Failure after Heart Valve Replacement

作　　者：任宇虹 于荣国[1] 林风辉[1] REN Yuhong;YU Rongguo;LIN Fenghui(No.4 Department of Critical Care Medicine,Fujian Provincial Hospital,Fujian Medical University,Fuzhou 350000,China)

机构地区：[1]福建医科大学省立临床医学院,福建省立医院重症医学四科,福建福州350000

出　　处：《中国医药指南》2021年第25期56-57,60,共3页Guide of China Medicine

摘　　要：目的分析老年患者心脏瓣膜置换术后发生急性肾衰竭透析治疗的高危因素。方法将本院2020年1月至2021年1月收治的60例老年心脏瓣膜病患者行人工心脏瓣膜置换术后按照是否并发急性肾衰竭旦需要透析治疗,分为肾衰竭组和非肾衰竭组,比对两组患者的接受人工心脏瓣膜置换术前后的各项生命体征,初步筛选单风险因素。将上述初筛为单风险因素的风险项设置为自变量,行Logistic回归分析,确定可致老年患者人工心脏瓣膜置换术后急性肾衰竭透析治疗的独立风险因素。结果初筛结果提示,体外循环时间长、NYHA心力衰竭评级高、LVEF左室射血分数较低、肌酐浓度高、尿素浓度高、伴有低心排综合征、24 h内输入库血量大是导致人工心脏瓣膜置换术后发生急性肾衰竭透析治疗的单风险因素,P<0.05。Logistic回归分析结果显示,所有初筛为单风险因素的风险项均为导致老年患者人工心脏瓣膜置换术后发生急性肾衰竭透析治疗的独立风险因素。结论采用人工心脏瓣膜置换术治疗老年心脏瓣膜病患者时,医护人员应重点关注体外循环时间、NYHA心力衰竭评级、LVEF左室射血分数、肌酐及尿素浓度、是否有低心排综合征、24 h内输入库血量7项因素,若相关数值偏离正常值,则应预防患者术后并发急性肾衰竭,并做好一切准备工作(含透析治疗)。Objective To analyze the high risk factors of acute renal failure after heart valve replacement in elderly patients.Methods From January 2020 to January 2021,60 patients with valvular heart disease over 65 years old were divided into renal failure group and non renal failure group according to whether it is complicated by acute renal failure and requires dialysis treatment.The vital signs before and after artificial heart valve replacement were compared between the two groups,and the single risk factors were preliminarily screened.Logistic regression analysis was performed to determine the independent risk factors for acute renal failure after artificial heart valve replacement in elderly patients.Results The preliminary screening results showed that long cardiopulmonary bypass time,high NYHA heart failure rating,low LVEF,high creatinine concentration,high urea concentration,low cardiac output syndrome and large blood transfusion volume within 24 hours were the single risk factors for acute renal failure after artificial heart valve replacement,P<0.05.Logistic regression analysis showed that all the risk items initially screened as single risk factors were independent risk factors for acute renal failure after artificial heart valve replacement in elderly patients.Conclusion When using artificial heart valve replacement to treat elderly patients with valvular heart disease,medical staff should pay attention to 7 factors,such as cardiopulmonary bypass time,heart failure rating,left ventricular ejection fraction,creatinine and urea concentration,whether there is low cardiac output syndrome,blood bank volume input within 24 hours,if the relevant value deviates from the normal value,the patient should be prevented from postoperative acute renal failure,and make all preparations(including dialysis treatment).

关 键 词：心脏瓣膜病 人工心脏瓣膜置换术 急性肾衰竭 透析治疗 

分 类 号：R692.5[医药卫生—泌尿科学]