急性A型主动脉夹层患者术后急性肾损伤的危险因素分析和列线图预测模型建立  

Risk factors and nomogram model establishment of postoperative acute kidney injury in patients with acute type A aortic dissection

作　　者：李威威 李佳冰 郭松青 张扬 陈鑫 林舜艳 杨柳青 高巨 LI Weiwei;LI Jiabing;GUO Songqing;ZHANG Yang;CHEN Xin;LIN Shunyan;YANG Liuqing;GAO Ju(Jiangsu Key Laboratory of Anesthesiology,Xuzhou Medical University,Xuzhou 221004,China)

机构地区：[1]徐州医科大学江苏麻醉学重点实验室,221004 [2]江苏省苏北人民医院麻醉科 [3]扬州大学临床医学院江苏省苏北人民医院麻醉科 [4]徐州医科大学扬州临床学院

出　　处：《临床麻醉学杂志》2025年第3期257-262,共6页Journal of Clinical Anesthesiology

基　　金：国家自然科学基金(82172190,82101299);江苏省卫生健康委员会医学科研项目(M2021105)。

摘　　要：目的分析急性A型主动脉夹层(ATAAD)患者术后急性肾损伤(AKI)的危险因素,并构建列线图模型。方法回顾性收集2019年8月至2023年5月行心血管手术的ATAAD患者183例,男83例,女100例,年龄≥18岁,BMI 16~30 kg/m^(2),ASAⅣ—Ⅴ级。收集患者一般情况、术前实验室检查、麻醉用药、术中和术后情况。根据术后7 d内AKI发生情况将患者分为两组:AKI组和非AKI组。采用多因素Logistic回归分析术后AKI的危险因素并构建列线图预测模型。结果有84例(45.9%)患者发生术后AKI。多因素Logistic回归分析结果显示,年龄增大(OR=1.055,95%CI 1.010~1.101,P=0.016)、肾氧饱和度降低(OR=0.569,95%CI 0.438~0.739,P<0.001)、红细胞输注量增加(OR=1.917,95%CI 1.231~2.985,P=0.004)、手术时间延长(OR=2.560,95%CI 1.569~4.175,P<0.001)、CPB时间延长(OR=1.004,95%CI 1.001~1.007,P=0.008)和低温停循环时间延长(OR=1.229,95%CI 1.116~1.354,P<0.001)是ATAAD患者术后AKI的独立危险因素,基于上述独立危险因素构建ATAAD患者术后AKI的列线图预测模型,结果显示,该模型AUC为0.939(95%CI 0.905~0.973),当截断值为0.61时,敏感性为81.0%,特异性为96.0%,提示该模型预测能力较好。结论年龄增大、肾氧饱和度降低、红细胞输注量增加、手术时间延长、CPB时间延长和低温停循环时间延长是ATAAD患者术后AKI的独立危险因素,基于此构建的列线图预测模型对ATAAD患者术后AKI有较好的预测价值。Objective To identify the risk factors and construct a nomogram model of postoperative acute kidney injury(AKI)in patients with acute type A aortic dissection(ATAAD).Methods A total of 183 ATAAD patients,83 males and 100 females,aged≥18 years,BMI 16-30 kg/m^(2),ASA physical statusⅣtoⅤ,who underwent cardiovascular surgery from August 2019 to May 2023 were selected.General information,preoperative laboratory test results,anesthetic drugs,intraoperative and postoperative indicators were collected.The patients were divided into two groups according to the occurrence of AKI within 7 days after surgery:the AKI group and the non-AKI group.Multivariable logistic regression was used to determine the risk factors and nomogram prediction model for AKI.Results Eighty-four patients(45.9%)developed AKI.Multivariate Logistic regression showed that increased age(OR=1.055,95%CI 1.010-1.101,P=0.016),reduced renal oxygen saturation(OR=0.569,95%CI 0.438-0.739,P<0.001),increased erythrocyte infusion(OR=1.917,95%CI 1.231-2.985,P=0.004),prolonged operative time(OR=2.560,95%CI 1.569-4.175,P<0.001),prolonged CPB time(OR=1.004,95%CI 1.001-1.007,P=0.008)and prolonged hypothermic circulatory arrest time(OR=1.229,95%CI 1.116-1.354,P<0.001)were independent risk factors of AKI after ATAAD surgery.Based on the above independent risk factors,a nomogram prediction model for postoperative AKI in ATAAD patients was constructed.The results showed that the AUC of the model was 0.939(95%CI 0.905~0.973),and when the cut-off value was 0.61,the sensitivity was 81.0%,the specificity was 96.0%,which suggested that this model has good prediction ability.Conclusion Increased age,reduced renal oxygen saturation,increased erythrocyte infusion,prolonged operative time,prolonged CPB time,and prolonged hypothermic circulatory arrest time are independent risk factors for AKI after ATAAD surgery.The nomogram prediction model based on this factor has good predictive value for postoperative AKI in patients with ATAAD.

关 键 词：急性A型主动脉夹层 急性肾损伤 危险因素 肾氧饱和度 

分 类 号：R69[医药卫生—泌尿科学]