急性A型主动脉夹层术后急性肾损伤行连续性肾脏替代治疗患者出院后90天内死亡的预后因素分析  

Prognosis factors for death within 90 days of discharge in patients with acute kidney injury requiring continuous renal replacement therapy after surgery for Stanford type A acute aortic dissection

作　　者：焦瑞[1] 鲁旭然 丁浩[1] 刘毛毛 刘楠[1] Jiao Rui;Lu Xuran;Ding Hao;Liu Maomao;Liu Nan(Center for Cardiac Intensive Care,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院心脏外科危重症中心,北京市心肺血管疾病研究所,北京100029

出　　处：《中华外科杂志》2022年第5期466-471,共6页Chinese Journal of Surgery

基　　金：首都临床诊疗技术研究及转化应用专项(Z191100006619095)。

摘　　要：目的探讨急性Stanford A型主动脉夹层(简称A型夹层)手术后发生急性肾损伤行连续性肾脏替代治疗(CRRT)患者出院后90 d内死亡的预后因素。方法回顾性分析2016年7月至2019年2月于首都医科大学附属北京安贞医院心脏外科因急性A型夹层术后发生急性肾损伤应用CRRT的126例患者的临床资料。男性83例,女性43例,年龄(52.9±11.2)岁(范围:25~70岁)。记录患者的人口学特征、疾病相关信息、围手术期资料、CRRT期间检验指标、并发症及患者出院后90 d内生存信息。通过Kaplan-Meier生存分析、单因素和多元Cox比例风险模型确定患者出院后90 d内死亡的预后因素。结果57例患者出院后90 d内死亡(45.2%,57/126)。Kaplan-Meier生存分析及单因素Cox比例风险模型分析结果显示,死亡组与生存组差异有统计学意义的项目包括患者年龄≥65岁、CRRT后12 h高乳酸值、肺部感染、肝功能障碍、存在永久性神经系统并发症、术后射血分数<45%(P值均<0.05)。将上述因素纳入多元Cox比例风险模型,结果显示,年龄≥65岁(HR=2.14,95%CI:1.09~4.21,P=0.03)、CRRT后12 h高乳酸值(HR=1.13,95%CI:1.06~1.20,P=0.01)、术后射血分数<45%(HR=2.21,95%CI:1.09~4.51,P=0.03)是患者出院后90 d死亡的预后因素。结论急性A型夹层术后发生急性肾损伤行CRRT的患者,出院后90 d内死亡的预后因素包括年龄≥65岁、CRRT后12 h高乳酸值、术后射血分数<45%,识别预后因素对提高此类患者的救治成功率可能有益。Objective To investigate the prognosis factors for death within 90 days after discharge in patients with acute kidney injury(AKI)treated requiring continuous renal replacement therapy(CRRT)undergoing surgery for acute Standford type A aortic dissection.Methods The clinic data of 126 patients undergoing CRRT for postoperative AKI after acute type A aortic dissection surgery in the Center for Cardiac Intensive Care,Beijing Anzhen Hospital from July 2016 to February 2019 were analyzed retrospectively.There were 83 males and 43 females,aging(52.9±11.2)years(range:25 to 70 years).The patients′demographic characteristics,disease-related information,perioperative data,laboratory indexes during CRRT,complications,and survival information within 90 days after discharge were recorded.Independent prognosis factors for death within 90 days of discharge were determined by Kaplan-Meier survival analysis,univariate and multifactorial Cox regression analysis.Results Totally 57 of 126 patients(45.2%)died over the first 90 days after discharge.Kaplan-Meier survival analysis and univariate Cox regression analysis showed that there were significant differences between the non-survival and survival group including≥65 years old,high lactate values 12 hours after CRRT,pulmonary infection,liver dysfunction,presence of permanent neurological complications,and postoperative ejection fraction(EF)<45%.Multifactorial Cox regression analysis revealed that≥65 years old(HR=2.14,95%CI:1.09 to 4.21,P=0.03),high lactate values 12 hours after CRRT(HR=1.13,95%CI:1.06 to 1.20,P=0.01)and postoperative EF<45%(HR=2.21,95%CI:1.09 to 4.51,P=0.03)were independent prognosis factors for patients′death within 90 days after hospital discharge.Conclusions≥65 years old,high lactate values 12 hours after CRRT and postoperative EF<45%are independent prognosis factors for death within 90 days after discharge in patients undergoing CRRT for AKI after acute type A aortic dissection surgery.Proper identification and management of prognosis factors could be

关 键 词：动脉瘤 夹层 肾功能不全 血液透析滤过 因素分析 统计学 

分 类 号：R654.3[医药卫生—外科学]