西部三线城市A型主动脉夹层术后肾损伤的回顾性分析  

Retrospective analysis of renal injury after surgery for Type A aortic dissection in western third-tier city

作　　者：刘芸 王刚 唐志清[1] 龙小菊 赵文涛 王永旺 LIU Yun;WANG Gang;TANG Zhiqing;LONG Xiaoju;ZHAO Wentao;WANG Yongwang(Department of Anesthesiology,Affiliated Hospital of Guilin Medical University,Guilin 541001,China)

机构地区：[1]桂林医学院附属医院麻醉科,广西桂林541001

出　　处：《麻醉安全与质控》2024年第3期135-140,共6页Perioperative Safety and Quality Assurance

基　　金：广西医疗卫生重点培育学科建设项目(2019年);桂林市科学研究与开发计划项目(20210227-4)。

摘　　要：目的探讨Stanford A型主动脉夹层患者术后急性肾损伤(AKI)及其需行连续性肾脏替代治疗(CRRT)的危险因素,总结围术期管理的经验及教训,为今后的临床实践提出建议。方法选取桂林医学院附属医院在2019-01/2023-05期间收治的Stanford A型主动脉夹层并行手术治疗患者31例。根据术后是否发生AKI分为AKI组(n=26)和非AKI组(n=5),根据AKI患者是否行CRRT分为CRRT组(n=5)和非CRRT组(n=21),比较患者的临床病例资料,进行单因素分析和多因素Logistic回归分析。结果纳入研究的31例患者中,术后发生AKI的患者26例(83.9%),91.7%的患者血肌酐能在2~14 d内恢复至术前水平,100%患者能在2个月内恢复,其中重度肾功能不全行CRRT者5例(16.1%)。多因素Logistic回归分析显示,术后白细胞(WBC)值是AKI患者行肾脏替代治疗的独立危险因素。结论Stanford A型主动脉夹层术后WBC值是AKI患者行肾脏替代治疗的独立危险因素。Objective To explore the risk factors of postoperative acute kidney injury(AKI)and the need for continuous renal replacement therapy(CRRT)in Stanford Type A aortic dissection patients,summarize the experience and lessons of perioperative management,and provide recommendations for future clinical practice.Methods The clinical data of 31 Stanford Type A aortic dissection patients undergoing concurrent surgical treatment were collected from January 2019 to May 2023 in the Affiliated Hospital of Guilin Medical University.According to whether AKI occurred after surgery,they were divided into AKI group(n=26)and non-AKI group(n=5).AKI patients were further divided into CRRT group(n=5)and non-CRRT group(n=21),according to whether they received CRRT.Clinical case data of patients were compared,and univariate analysis and multivariate logistic regression analysis were performed.Results Among the 31 patients included in the study,26 patients(83.9%)had postoperative AKI,91.7%of patients could recover to the preoperative level of serum creatinine(SCr)within 2-14 days,100%of patients could recover within 2 months,and 5 patients(16.1%)with severe renal insufficiency had received CRRT.Multivariate Logistic regression analysis showed that postoperative WBC was an independent risk factor for renal replacement therapy in AKI patients.Conclusion After surgery for Type A aortic dissection,WBCs count is an independent risk factor for renal replacement therapy in AKI patients.

关 键 词：Stanford A型主动脉夹层 急性肾损伤 肾脏替代治疗 

分 类 号：R614[医药卫生—麻醉学]