心脏外科手术后静脉应用呋塞米对患者发生急性肾损伤的影响  

Effect of intravenous application of furosemide on occurrence of acute kidney injury in patients aftercardiac

作　　者：范彩霞 徐坤 李洪艳 刘文启[1] 朱宗法 李峥嵘[1] 毕云彦 张士林[1] 朱晓松 王世明[6] Fan Caixia;Xu Kun;Li Hongyan;Liu Wenqi;Zhu Zongfa;Li Zhengrong;Bi Yunyan;Zhang Shilin;Zhu Xiaosong;Wang Shiming(Department of Pharmacy,Linyi People’s Hospital,Shandong Province,Linyi 276000,China;Physical Examination Center,Qingdao Sixth People’s Hospital,Shandong Province,Qingdao 266033,China;Department of Infection Management,Linyi People’s Hospital,Shandong Province,Linyi 276000,China;Department of Phamacy,Haiyan People’s Hospital,Qinghai Province,Haiyan 812299,China;Graduate Department of Shandong First Medical University(Shandong Academy of Medical Sciences),Ji’nan 250117,China;Department of Geriatrics,Linyi People’s Hospital,Shandong Province,Linyi 276000,China)

机构地区：[1]临沂市人民医院药学部,临沂276000 [2]青岛市第六人民医院体检中心,青岛266033 [3]临沂市人民医院感染管理部,临沂276000 [4]青海省海晏县人民医院药剂科,海晏812299 [5]山东第一医科大学(山东省医学科学院)研究生部,济南250117 [6]临沂市人民医院老年医学科,临沂276000

出　　处：《药物不良反应杂志》2024年第4期198-203,共6页Adverse Drug Reactions Journal

基　　金：山东省自然科学基金(ZR2020QH332);山东省医学会临床科研资金(YHX2022ZX02066)

摘　　要：目的探讨心脏外科手术后静脉应用呋塞米对患者发生心脏手术相关急性肾损伤(CSA⁃AKI)的影响。方法收集2014年1月至2022年12月在临沂市人民医院接受心脏外科手术患者的电子病历进行回顾性分析。根据术后是否发生CSA⁃AKI,将患者分为AKI组和非AKI组,比较2组患者的临床特征,采用多因素logistic回归方法分析发生CSA⁃AKI的影响因素,计算优势比(OR)及其95%置信区间(CI)。结果纳入分析的患者共2633例,男性1601例(60.8%),女性1032例(39.2%);年龄(62.8±8.9)岁,范围18~85岁;491例(18.6%)发生了CSA⁃AKI。多因素logistic回归分析结果显示,在校正了手术类型,术中采用体外循环,合并高血压病、糖尿病、低白蛋白血症、NYHA心功能分级Ⅲ/Ⅳ级,术中/术后接受主动脉球囊反搏治疗,术前血肌酐水平,手术持续时间,术后使用血管活性药物种数等因素后,术后静脉使用呋塞米与CSA⁃AKI的发生独立相关(OR=2.161,95%CI:1.720~2.715,P<0.001)。结论纳入本研究患者的CSA⁃AKI发生率为18.6%,心脏外科手术后静脉使用呋塞米可增加CSA⁃AKI的发生风险。Objective To investigate the effect of intravenous application of furosemide on occurrence of cardiac surgery-associated acute kidney injury(CSA-AKI)in patients after cardiac surgery.Methods The electronic medical records of patients undergoing cardiac surgery in Linyi People’s Hospital from January 2014 to December 2022 were collected and retrospectively analyzed.According to whether CSA-AKI occurred after surgery,the patients were divided into AKI group and non-AKI group and the clinical characteristics between the 2 groups were compared.Multivariate logistic regression was used to analyze the influencing factors of CSA-AKI,and the odds ratio(OR)and its 95% confidence interval(CI)were calculated.Results A total of 2633 patients were enrolled in the analysis,including 1601 males(60.8%)and 1032 females(39.2%).The age was(62.8±8.9)years,ranging from 18 to 85 years.Among the 2633 patients,491(18.6%)developed CSA-AKI.Multivariate logistic regression analysis showed that after adjusting for factors such as the type of operation,intraoperative cardiopulmonary bypass,hypertension,diabetes mellitus,hypoalbuminemia,NYHA cardiac function class Ⅲ/Ⅳ,intraoperative/postoperative aortic balloon counterpulsation,preoperative serum creatinine level,operation duration,and the number of vasoactive drugs used after the operation,postoperative intravenous application of furosemide was still independently associated with the occurrence of CSA-AKI(OR=2.161,95%CI:1.720-2.715,P<0.001).Conclusions The incidence of CSA-AKI in patients enrolled in this study was 18.6%.Intravenous use of furosemide after cardiac surgery can increase the risk of CSA-AKI.

关 键 词：心脏外科手术 呋塞米 肾功能不全 危险因素 

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