急性Stanford A型主动脉夹层术后行连续肾脏替代疗法的危险因素分析  

Analysis of risk factors and prevention strategies for CRRT after acute Stanford Type A aortic dissection surgery

作　　者：张雪花 董柱 毕生辉 喻雪飞 李雅玲[2] 杨博 王晓武 ZHANG Xuehua;DONG Zhu;BI Shenghui;YU Xuefei;LI Yaling;YANG Bo;WANG Xiaowu(Gradu-ate School,Guangzhou University of Chinese Medicine,Guangzhou 510010,China;不详)

机构地区：[1]广州中医药大学研究生院,广州510010 [2]南方医科大学珠江医院,广州510280

出　　处：《实用医学杂志》2022年第10期1226-1230,共5页The Journal of Practical Medicine

基　　金：国家自然科学基金面上项目(编号:81671885);广东省医学科研基金项目(编号:C2021057);广州市科技计划项目(编号:201607010310);广州市珠江科技新星专项(编号:201610010094);军委后勤保障部面上项目(编号:18BJZ15)。

摘　　要：目的探究急性Stanford A型主动脉夹层术后行连续肾脏替代疗法(CRRT)的独立危险因素及预防策略。方法回顾性分析南方医科大学珠江医院2020年9月至2021年12月收治的急性Stanford A型主动脉夹层患者115例(男/女为93/22),年龄(53.16±11.43)岁;根据术后是否行CRRT将术后患者分为CRRT组(n=23),非CRRT组(n=92),采用单因素分析得出危险因素并纳入多因素logistic回归以明确独立危险因素。结果围术期死亡19例(16.88%),其中CRRT组死亡9例,非CRRT组死亡10例,两组死亡率差异有统计学意义(χ^(2)=10.655,P=0.001)。CRRT组与非CRRT组单因素分析提示术前肌酐、术前夹层累及肾动脉、阻断时间、体外循环时间、手术时间、术中输红细胞量、术中输血浆量与急性Stanford A型主动脉夹层术后行CRRT有关,而经logistic回归分析进一步明确术前肌酐(OR=1.875,P=0.014)、阻断时间(OR=1.874,P=0.008)、手术时间(OR=1.014,P=0.012)、术中输红细胞量(OR=2.183,P=0.017)为急性Stanford A型主动脉夹层术后行CRRT的独立危险因素。ROC曲线分析得出,术前肌酐在预测急性Stanford A型主动脉夹层术后行CRRT的效能最高。结论术前肌酐、阻断时间、体外循环时间和术中输红细胞量是急性Stanford A型主动脉夹层术后行CRRT的独立危险因素;围手术期对患者实施有效评估和对应措施,可降低急性Stanford A型主动脉夹层术后行CRRT的风险。Objective The aim of this study was to analyzed the CRRT factors of acute Stanford type A aortic dissection surgery retrospectively and identify the risk factors for CRRT after acute Stanford type A aortic dissection surgery.Methods 115 patients(93 males and 22 females,at a mean age of(53.16±11.43)years with acute Stanford type A aortic dissection at the cardiovascular surgery department of our hospital from September 2020 to December 2021)were collected and retrospectively analyzed.23 patients were acute kidney injury after re⁃ceive acute Stanford type A aortic dissection surgery were assigned into the CRRT group,and the remaining pa⁃tients(n=92)were included in the non⁃CRRT group.The perioperative data were reviewed and the risk factors were identified by univariate analysis,which further confirmed by logistic regression.Results There were 19 pa⁃tients dead during perioperative period in our study.There were 9 deaths in the CRRT group and 10 deaths in the non⁃CRRT group.The mortality of the two groups was statistically significant(χ^(2)=10.655,P=0.001).Univariate analysis identified Preoperative creatinine,block time,extracorporeal circulation time,operation time,intraopera⁃tive red blood cell volume,intraoperative plasma volume were risk factors for CRRT after acute Stanford type A aor⁃tic dissection surgery.Logistic regression analysis further identified preoperative creatinine(OR=1.875,P=0.014),blocking time(OR=1.874,P=0.008),time of operation(OR=1.014,P=0.012)and intraoperative erythrocyte transfusion(OR=2.183,P=0.017)were independent risk factors for CRRT after acute Stanford type A aortic dissection surgery.The receiver operating characteristic(ROC)curve analysis showed that preoperative creatinine was the most effective in predicting postoperative CRRT of acute Stanford type A aortic dissection.Conclusion It was confirmed that preoperative creatinine,block time,CPB time and intraoperative red blood cell volume were independent risk factors for CRRT after acute Stanford Type A aortic disse

关 键 词：急性主动脉夹层 连续肾脏替代疗法 危险因素 

分 类 号：R543.1[医药卫生—心血管疾病]