心脏瓣膜置换术后急性肾损伤危险因素分析及干预策略  

Analysis of risk factors and intervention strategies for acute kidney injury after cardiac valve replacement

作　　者：刘旭东[1] 马富珍[1] 李艳婷 吴喜娥 宋艳艳[1] LIU Xudong;MA Fuzhen;LI Yanting;WU Xi’e;SONG Yanyan(Department of Cardiovascular Surgery,General Hospital of Ningxia Medical University,Yinchuan 750004,China)

机构地区：[1]宁夏医科大学总医院心脏大血管外科,宁夏银川750004

出　　处：《宁夏医学杂志》2023年第7期604-607,共4页Ningxia Medical Journal

基　　金：宁夏高等学校科学技术研究项目资助(NYG2022047)。

摘　　要：目的探讨体外循环心脏瓣膜置换术后发生急性肾损伤(AKI)的危险因素及干预策略。方法纳入患有心脏瓣膜病并进行体外循环心脏瓣膜置换手术的患者共106例。其中男性66例,女性40例,年龄43~72岁,平均年龄(57.8±10.9)岁。依据术后是否发生急性肾损伤分为AKI组和非AKI组,比较2组患者术前、术中、术后的临床资料,采用单因素分析和多因素logistic回归分析方法,探讨体外循环心脏瓣膜置换术后急性肾损伤的危险因素,以便尽早给予患者肾脏功能保护策略,改善预后。结果106例患者术后发生AKI 24例,AKI发生率22.64%,术后院内死亡2例,院内死亡率8.33%;非AKI组82例,院内死亡2例,院内死亡率2.43%,2组之间死亡率比较,差异有统计学意义(P<0.05)。单因素分析显示,年龄、术前血肌酐>130μmol/L、左室射血分数(LVEF)<45%、存在感染性心内膜炎(SIE)、同期行冠状动脉旁路移植术(CABG)、体外循环时间、手术时间、平均动脉压(MAP)<70 mmHg、尿量<0.5 mL/(kg·h)、肺部感染、低心排、术后菌血症是术后AKI的危险因素。多因素logistic回归分析显示,术前血肌酐>130μmol/L、LVEF<45%、合并SIE、体外循环时间>2 h、术中及术后低血压、低心排、术后菌血症是术后AKI的独立危险因素。结论术前血肌酐>130μmol/L、LVEF<45%、合并SIE、体外循环时间>2 h、术中及术后低血压、低心排、术后菌血症是术后AKI的独立危险因素,围术期积极采取干预策略可以降低术后AKI的发生,改善患者预后。Objective To investigate the risk factors and intervention strategies for the development of acute kidney injury(AKI)after cardiac valve replacement.Methods The clinical data of a total of 106 patients diagnosed with heart valve disease and undergoing extracorporeal circulation heart valve replacement surgery were analyzed.Among them,66 cases were male,and 40 cases were female,aged 43 to 72 years,with an average of(57.8±10.9)years.The two groups were divided into AKI and non-AKI groups according to whether acute kidney injury occurred after surgery,and the preoperative,intraoperative and postoperative clinical data were compared.Single-factor analysis and multi-factor logistic regression analysis were used to explore the risk factors for acute kidney injury after extracorporeal heart valve replacement,and to improve the prognosis by giving kidney function protection strategies as early as possible.Results 24 cases of postoperative AKI occurred in 106 patients,with an AKI incidence rate of 22.64%,two cases of postoperative in-hospital death and an in-hospital mortality rate of 8.33%,and 82 cases in the non-AKI group,with two cases of in-hospital death and in-hospital mortality rate of 2.43%.The difference in mortality between the two groups was statistically significant(P<0.05).Univariate analysis showed that age,preoperative blood creatinine>130umol/L,LVEF<45%,presence of subacute infective endocarditis(SIE),concurrent coronary artery bypass grafting(CABG),time to extracorporeal circulation,time to surgery,MAP<70 mmHg,urine output<0.5 ml/(kg·h),pulmonary infection,low cardiac output,and bacteremia were risk factors for postoperative AKI.Multi-factor regression analysis showed that preoperative blood creatinine more than 130umol/l,LVEF less than 45%,combined infective endocarditis,extracorporeal circulation time>2 h,intraoperative and postoperative hypotension,low cardiac output,and postoperative bacteremia were independent risk factors for postoperative AKI.Conclusion Preoperative blood creatinine more than 130

关 键 词：心脏瓣膜置换手术 急性肾损伤 危险因素 干预策略 

分 类 号：R654.2[医药卫生—外科学]