术前肾功能对急性Stanford A型主动脉夹层术后重度AKI的影响  

Preoperative renal function and postoperative severe AKI in patients with acute type A aortic dissection

作　　者：崔亚玲 陈海生 张春曦 李彬 张海 叶东挺 CUI Yaling;CHEN Haisheng;ZHANG Chunxi;LI Bin;ZHANG Hai;YE Dongting(Cardiovascular Surgery,Guangzhou First People’s Hospital,Second Affiliated Hospital,School of Medicine,South China University of Technology,Guangzhou 510180,China)

机构地区：[1]广州市第一人民医院(华南理工大学附属第二医院)心脏大血管外科,广东广州510180

出　　处：《广州医药》2024年第11期1290-1296,共7页Guangzhou Medical Journal

摘　　要：目的探讨术前血清肌酐(sCr)、估测肾小球滤过率(eGFR)对急性A型夹层术后急性肾损伤3级(AKI 3级)及连续性肾脏替代治疗(CRRT)的影响。方法回顾性分析广州市第一人民医院2017年1月-2022年12月6年间收治的143例行Bentall或升主动脉置换+Sun’s手术的急性Stanford A型夹层患者术前sCr及eGFR、术后24 h及48 h sCr、尿量、术后AKI及CRRT情况。应用ROC曲线(受试者特征曲线)分析术前sCr、eGFR对术后AKI 3级及CRRT的影响。结果术后AKI 3级27例(18.9%),CRRT 14例(9.8%)。发生AKI 3级及CRRT的患者术前sCr水平升高(AKI3级与AKI0-2级组间比较t’=-2.722,P=0.011,CRRT与非CRRT组间比较t’=-2.184,P=0.048)、eGFR降低(AKI3级与AKI0-2级组间比较t=4.585,P<0.001,CRRT与非CRRT组间比较t=4.932,P<0.001)。ROC曲线分析提示术前sCr可有效预测术后AKI 3级(AUC 0.768,临界点123μmol/L,灵敏度67%,特异度85%)及CRRT(AUC 0.848,临界点137.5μmol/L,灵敏度71%,特异度88%)。eGFR可预测AKI 3级[AUC 0.761,临界点56.25 mL/(min·1.73 m^(2)),灵敏度67%,特异度83%]及CRRT[AUC 0.855,临界点47.6 mL/(min·1.73 m^(2)),灵敏度71%,特异度87%]。手术合并低心排血量等肾灌注不良时,eGFR低于75.9 mL/(min·1.73 m^(2)),术后CRRT发生率增加。结论急性A型夹层术前sCr及eGFR影响术后AKI 3级及CRRT的发生。sCr>123μmol/L、eGFR低于58.25 mL/(min·1.73 m^(2))的患者术后AKI 3级发生率增加。sCr>137.5μmol/L、eGFR低于47.6 mL/(min·1.73 m^(2)),或合并肾灌注不良的患者术后CRRT发生率增加。Objective To explore the influences of preoperative serum creatinine(sCr)and estimated glomerular filtration rate(eGFR)on postoperative stage 3 acute kidney injury(AKI)or continuous renal replacement treatment(CRRT)in patients with acute Stanford type A aortic dissection(ATAAD).Methods From July 2017 to December 2022,143 ATAAD patients who underwent Bentall or ascending aortic replacement and total arch replacement and stented elephant trunk were retrospective analyzed.Data included preoperative sCr and eGFR,postoperative sCr,eGFR,urine volume,AKI and CRRT at 24 h and 48 h.Receiver operating characteristic(ROC)curve were used to analyze the influences of preoperative sCr and eGFR on stage 3 AKI and CRRT.Results Stage 3 AKI occurred in 27(18.9%)patients,including 14 patients who required CRRT.sCr was significantly higher in stage 3 AKI or CRRT group(AKI 3 vs AKI 0-2 group:t’=-2.722,P=0.011,CRRT vs non-CRRT group:t’=-2.184,P=0.048),and eGFR was significantly lower(AKI 3 vs AKI 0-2 group:t=4.585,P<0.001,CRRT vs non-CRRT group:t=4.932,P<0.001).Preoperative sCr could effectively predict postoperative stage 3 AKI(AUC 0.768,the best cut-off value was 123μmol/L,sensitivity 67%,specificity 85%)and CRRT(AUC 0.848,the best cut-off value was 137.5μmol/L,sensitivity 71%,specificity 88%).Preoperative eGFR could predict postoperative stage 3 AKI(AUC 0.761,the best cut-off value was 56.25mL/(min·1.73 m^(2)),sensitivity 67%,specificity 83%)and CRRT(AUC 0.855,the best cut-off value was 47.6 mL/(min·1.73 m^(2)),sensitivity 71%,specificity 87%).CRRT requirement significantly increased in patients with eGFR lower than 75.9 mL/(min·1.73 m^(2))who complicated with peripheral malperfusion.Conclusions Preoperative sCr and eGFR have significant influences on incidence of postoperative stage 3 AKI and CRRT.Postoperative stage 3 AKI significantly increase in patients with sCr more than 123μmol/L or eGFR lower than 56.25mL/(min·1.73 m^(2)).Postoperative CRRT significantly increase in patients with sCr more than 137.5μmol/L,eGFR l

关 键 词：Stanford A型主动脉夹层 血清肌酐 估测肾小球滤过率 急性肾损伤 连续性肾脏替代治疗 

分 类 号：R654.3[医药卫生—外科学] R692.5[医药卫生—临床医学]