体外循环持续时间对主动脉术后急性肾损伤的影响  

Cardiopulmonary bypass duration is an independent risk factor for acute kidney injury in aortic surgery

作　　者：许士俊 贡鸣[1] 李扬[1] 刘韬帅[1] 董然[1] 张宏家[1] XU Shijun;GONG Ming;LI Yang;LIU Taoshuai;DONG Ran;ZHANG Hongjia(Department of Cardiac Surgery,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-北京市心肺血管疾病研究所心脏外科,100029

出　　处：《心肺血管病杂志》2023年第10期1049-1055,共7页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:探讨体外循环持续时间和急性Stanford A型主动脉夹层术后的关系。方法:回顾性收集2015年12月到2017年4月间在首都医科大学附属北京安贞医院因急性Stanford A型主动脉夹层接受孙氏手术的患者,体外循环时间在手术中记录。急性肾损伤的定义基于KDIGO标准。结果:最终分析817例连续患者。急性肾损伤的总发生率为37.3%(n=305)。平均年龄(48.3±11.4)岁;73%是男性。平均体外循环时间(200.1±51.3)min。住院死亡率为8.6%。多变量Logistic回归显示,在调整混杂因素后,体外循环持续时间与术后急性肾损伤的发生独立相关(OR=1.006,95%CI:1.001~1.011,P=0.020)。结论:体外循环持续时间是急性Stanford A型主动脉夹层接受孙氏手术后发生急性肾损伤的独立危险因素,进一步了解这种联系的机制对预防策略的设计至关重要。Objective:Aortic surgery and cardiopulmonary bypass are both associated with development of postoperative acute kidney injury.In this study,we undertook to investigate the relationship between cardiopulmonary bypass duration and postoperative acute kidney injury in patients undergoing aortic surgery for Stanford type A aortic dissection.Methods:All patients receiving aortic surgery for Stanford type A aortic dissection in Beijing anzhen hospital from December 2015 to April 2017 were included.Cardiopulmonary bypass duration was recorded during surgery.Acute kidney injury was defined based on the Kidney Disease Improving Global Outcomes criteria.Results:A total of 817 consecutive patients were eventually analyzed.The overall incidence of acute kidney injury was 37.3%(n=305).The average age was(48.3±11.4)years;73%were male.Mean cardiopulmonary bypass duration was(200.1±51.3)min.In-hospital mortality was 8.6%.Multivariate Logistic regression revealed that cardiopulmonary bypass duration was independently associated with the occurrence of postoperative acute kidney injury after adjust confounding factors(OR=1.006,95%CI:1.001-1.011,P=0.020).Conclusions:Cardiopulmonary bypass duration is independently associated with an increased hazard of acute kidney injury after aortic surgery or Stanford type A aortic dissection.Further understanding of the mechanism of this association is crucial to the design of preventative strategies.

关 键 词：急性肾损伤 主动脉手术 体外循环 风险因素 主动脉夹层 

分 类 号：R54[医药卫生—心血管疾病]