心脏移植术后急性肾损伤风险因素:单中心报告  

Acute kidney injury risk factors after heart transplantation:a single-center report

作　　者：袁莉 刘峻江 杨兆华 杨守国 张红强 王帆顺 刘欢 王春生 孙晓宁 YUAN Li;LIU Jun-jiang;YANG Zhao-hua;YANG Shou-guo;ZHANG Hong-qiang;WANG Fan-shun;LIU Huan;WANG Chun-sheng;SUN Xiao-ning(Department of Cardiac Surgery,Zhongshan Hospital,Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学附属中山医院心外科,上海200032

出　　处：《复旦学报（医学版）》2023年第4期502-508,共7页Fudan University Journal of Medical Sciences

基　　金：国家自然科学基金(81970442)。

摘　　要：目的评估心脏移植术后早期急性肾损伤(acute kidney injury,AKI)的发生率、相关的危险因素及预后。方法收集2016年1月至2021年3月于复旦大学附属中山医院接受心脏移植的89例患者的人口学、临床实验室以及临床影像数据,进行有序多因素Logistic回归分析。结果89例患者中,43例(48.3%)患者术后发生了AKI,其中12例(13.5%)为AKI 1期,5例(5.6%)为AKI 2期,26例(29.2%)为AKI 3期。AKI是移植术后死亡的独立危险因素(log-rank:17.697,P=0.001),并且AKI分期与术中术后体外膜肺氧合风险呈正相关(P=0.003)。术后AKI进展的独立危险因素为体外循环时间>170 min(OR:5.663;95%CI:2.282~14.051;P<0.001)以及术中输注红细胞>4 IU(OR:10.687;95%CI:1.883~60.657;P=0.007)。结论心脏移植患者术后AKI发生率较高,是影响心脏移植患者预后的重要危险因素。体外循环时间>170 min、术中输注红细胞>4 IU是预测心脏移植术后发生AKI的独立危险因素,针对这些危险因素进行合理管理有可能减少术后AKI的发生。Objective To assess the incidence,associated risk factors,and prognosis of early postoperative acute kidney injury(AKI)after heart transplantation.Methods We collected the data of demography,clinical laboratories,and medical image from 89 patients who underwent heart transplantation in Zhongshan Hospital,Fudan University from Jan 2016 to Mar 2021 and performed an ordered multivariate Logistic regression analysis.Results Of the 89 patients,43 patients developed AKI postoperatively,with an incidence of 48.3%.Twelve(13.5%)of these patients were classified as AKI stage 1,5(5.6%)as AKI stage 2,and 26(29.2%)as AKI stage 3.AKI after heart transplantation was a risk factor for post-transplant mortality(log-rank:17.697,P=0.001).The higher stage of AKI was positively correlated with the risk of the higher proportion of patients under the intraoperative and postoperative extra-corporeal membrane oxygenation(ECMO)mechanical circulatory support(P=0.003).The independent risk factors for early development of AKI were the cardiopulmonary bypass time over 170 min(OR:5.663;95%CI:2.282-14.051;P<0.001)and the intraoperative infusion of red blood cells over four units(OR:10.687;95%CI:1.883-60.657;P=0.007).Conclusion The incidence of postoperative AKI is high in heart transplant patients,and its occurrence is an important risk factor affecting the prognosis of those patients.The cardiopulmonary bypass time over 170 minutes and the intraoperative red blood cell infusion of more than 4 units are the independent risk factors predicting the development of AKI after heart transplantation.Management of these risk factors may reduce the occurrence of postoperative AKI.

关 键 词：心脏移植 急性肾损伤(AKI) 体外循环时间 

分 类 号：R654.2[医药卫生—外科学]