中度低温下行全弓置换手术后接受连续性肾脏替代治疗的危险因素分析  

Risk factors for continuous renal replacement therapy after total arch replacement of Stanford type A aortic dissection under moderate hypothermia circulatory arrest

作　　者：李博[1] 陈庆良[1] 姚博宸 郭志刚[1] 姜楠[1] Li Bo;Chen Qingliang;Yao Bochen;Guo Zhigang;Jiang Nan(Department of Cardiovascular Surgery,Tianjin Chest Hospital,Tianjin 300001,China)

机构地区：[1]天津市胸科医院心脏外科,天津300001

出　　处：《中华胸心血管外科杂志》2022年第8期476-480,共5页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：天津市科技计划项目(18ZXDBSY00160)。

摘　　要：目的:探讨中度低温下全弓置换术后发生急性肾损伤并行连续性肾脏替代治疗(CRRT)的危险因素。方法:2017年10月至2020年3月天津市胸科医院心脏外科收治Stanford A型主动脉夹层,并在中度低温停循环下行全弓置换手术患者121例,其中行CRRT治疗49例(CRRT组),未行CRRT治疗72例(对照组)。两组均选择中低温脑保护策略,左颈总动脉和无名动脉顺行脑灌注。分析患者基本资料、围手术期情况以及手术过程。结果:两组患者年龄、性别、吸烟史、饮酒史差异无统计学意义(P>0.10)。两组在主动脉窦部直径和是否同期行Bentall手术差异有统计学意义(P≤0.05)。术后1天,CRRT组患者血肌酐(sCr)较对照组显著升高[(214.04±79.51)μmol/L对(127.32±58.08)μmol/L]。术后2~4天sCr变化趋势不明显。对照组在术后4天sCr较CRRT组显著下降[(264.20±111.76)μmol/L对(104.24±76.00)μmol/L]。主动脉窦部直径、合并Bentall手术、术中红细胞输血量、术中血小板输血量、术中自体血输血量、术中出血与术后是否行CRRT呈正相关(P<0.10),而术中血浆输血量与术后行CRRT治疗呈负相关(P<0.05)。结论:Stanford A型主动脉夹层患者术前主动脉窦部直径、合并Bentall手术、术中输血制品和术中出血是术后行CRRT的危险因素。Objective To investigate the risk factors of acute kidney injury(AKI)combined with continuous renal replacement therapy(CRRT)after Stanford type A dissection under moderate hypothermia circulatory arrest(MHCA).Methods From October 2017 to March 2020,all patients with Stanford type A dissection and total arch replacement surgery under MHCA were enrolled.According to whether receiving CRRT treatment,the patients were divided into CRRT group(49 cases)and control group(72 cases).Both tow groups chose the brain protection strategy of moderate hypothermia,the left common carotid artery and the innominate artery were perfused anteriorly.Relevant medical data was collected.Results There was no statistical difference in age,sex,smoking history,and drinking history between the two groups of patients(P>0.10).There were statistical differences between the two groups in the diameter of the aortic sinus and whether Bentall surgery was performed at the same time(P≤0.05).On the 1st postoperative day,the serum creatinine(sCr)of the CRRT group was significantly higher than that of the control group[(214.04±79.51)μmol/L vs.(127.32±58.08)μmol/L].The change trend of sCr was not obvious within 2 to 4 days after operation.The sCr of the control group was significantly lower than that of the CRRT group within 4 days after surgery[(264.20±111.76)μmol/L vs.(104.24±76.00)μmol/L].The diameter of aortic sinus,combined with Bentall surgery,intraoperative red blood cell transfusion,intraoperative platelet transfusion,intraoperative autologous blood transfusion,intraoperative bleeding were positively correlated with whether CRRT was performed after surgery(P<0.10),while intraoperative plasma The amount of blood transfusion was negatively correlated with postoperative CRRT(P<0.05).Conclusion The diameter of the aortic sinus before surgery,combined Bentall surgery,intraoperative blood transfusion products and intraoperative bleeding are risk factors for postoperative CRRT.

关 键 词：主动脉夹层 连续性肾脏替代治疗 中度低温停循环 回归分析 

分 类 号：R654.2[医药卫生—外科学] R692.5[医药卫生—临床医学]