心脏及血管手术后急性肾损伤的危险因素分析  

Analysis of risk factors for cardiovascular surgery-associated acute kidney injury

作　　者：后青 陆凤霞 姚昊[2] 徐卓[1] 李庆国[2] 戴春笋[1] Hou Qing;Lu Feng-xia;Yao Hao;Xu Zhuo;Li Qing-guo;Dai Chun-sun(Center for Kidney Disease,Second Affiliated Hospital,Nanjing Medical University,Nanjing 210003,China;Cardiovascualr Center,Second Affiliated Hospital,Nanjing Medical University,Nanjing 210003,China)

机构地区：[1]南京医科大学第二附属医院肾脏病医学中心,南京210003 [2]南京医科大学第二附属医院心血管中心,南京210003

出　　处：《临床肾脏病杂志》2022年第1期5-9,共5页Journal Of Clinical Nephrology

摘　　要：目的探究心脏及血管手术后急性肾损伤(cardiac and vascular surgery-associated acute kidney injury,CVS-AKI)发生的危险因素并建立CVS-AKI的预测模型。方法收集2016年6月至2019年12月于南京医科大学第二附属医院心血管中心在体外循环下行心脏及血管手术的269例患者的临床资料,将其纳入模型建立组,基于2012年KDIGO关于AKI的诊断标准,进行回顾性分析,统计CVS-AKI的发病率,分析CVS-AKI的危险因素并建立预测模型。将2020年4月开始入组的CVS-AKI前瞻性队列中的25例患者纳入模型验证组,评估模型的预测准确度。结果本研究中心CVS-AKI的发生率为62.5%(168/269),AKI1、2、3期的发生率分别为40.1%(108/269)、11.9%(32/269)、10.4%(28/269),肾脏替代治疗率为5.6%(15/269)。Logistic多因素回归分析显示高龄、高体重指数(body mass index,BMI)、长时间体外循环以及术后长时间机械通气为CVS-AKI发生的独立危险因素,建立预测模型CVS-AKI发生率=e^(Logit(P))/e^(Logit(P))+1,Logit(P)=0.027×年龄(岁)+0.109×BMI(kg/m^(2))+0.006×体外循环时间(min)+0.009×术后机械通气时间(h)-4.834,该模型的AUC为0.675(95%CI为0.407-0.944,P=0.203)。结论本中心CVS-AKI的发生率为62.5%,高龄、高BMI、长时间体外循环及术后机械通气为CVS-AKI发生的独立危险因素,根据这些危险因素建立的预测模型具有较好的预测准确度。Objective To explore the risk factors and establish a prediction model of cardiovas⁃cular surgery(CVS)-associated acute kidney injury(AKI).Methods From June 2016 to December 2019,retrospective analysis was conducted for 269 patients undergoing cardiovascular surgery with the aid of cardiopulmonary bypass(CPB).The incidence and risk factors of CVS-AKI were analyzed based upon the criteria for AKI of 2012 KDIGO.A prediction model was established and validated in a prospec⁃tive cohort of 25 patients since April 2020.Results The incidence of CVS-AKI was 62.5%(168/269),the incidence of AKI stage 1/2/340.1%(108/269),11.9%(32/269)and 10.4%(28/269)respectively and the rate of renal replacement therapy 5.6%(15/269).Logistic stepwise regression indicated that ad⁃vanced age,higher body mass index(BMI)and longer CPB and mechanical ventilation were independent risk factors of CVS-AKI.The predictive incidence of CVS-AKI=e^(Logit(P))/e^(Logit(P))+1,Logit(P)=0.027×age(year)+0.109×BMI(kg/m^(2))+0.006×CPB time(min)+0.009×mechanical ventilation time(h)after surgery(h)-4.834.The model had an excellent discrimination with 0.675 AUC(area under the curve)(95CI:0.407-0.944,P=0.203).Conclusion The incidence of CVS-AKI at our single center was 62.5%.The independent risk factors of CVS-AKI were advanced age,higher BMI,longer CPB and post⁃operative mechanical ventilation.The established model may predict the incidence of CVS-AKI properly.

关 键 词：急性肾损伤 心脏外科手术 血管外科手术 危险因素 

分 类 号：R654[医药卫生—外科学] R692[医药卫生—临床医学]