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中华重症医学电子杂志 ›› 2017, Vol. 03 ›› Issue (04): 275 -279. doi: 10.3877/cma.j.issn.2096-1537.2017.04.009

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临床研究 上一篇    下一篇

急性Stanford A型主动脉夹层患者术后并发急性肾损伤危险因素的回顾性研究
石海鹏 1, 王秀哲 1, 杨晓静 1, 夏艳梅 1, 武卫东 1 , ( ), 武文静 1, 杨灵波 2   
  1. 1. 030032 太原,山西医学科学院 山西大医院重症医学科
    2. 030032 太原,山西医学科学院 山西大医院心脏大血管外科
  • 收稿日期:2017-04-19 出版日期:2017-11-28
  • 通信作者: 武卫东
  • 基金资助:
    山西省卫生厅科技攻关资助项目(2012-01050); 山西省科技厅资助项目(20150313011-1)

A retrospective study of analysis of risk factors of postoperative acute kidney injury in acute Stanford type A aortic dissection

Haipeng Shi 1, Xiuzhe Wang 1, Xiaojing Yang 1, Yanmei Xia 1, Weidong Wu 1 , ( ), wenjing Wu 1, Lingbo Yang 2   

  1. 1. Department of Critical Care Medicine, ShanXi DaYi Hospital, Taiyuan 030032, China
    2. Department of Cardiac surgery , ShanXi DaYi Hospital, Taiyuan 030032, China
  • Received:2017-04-19 Published:2017-11-28
  • Corresponding author: Weidong Wu
  • About author:
    Corresponding author: Wu Weidong, Email:
目的

分析急性Stanford A型主动脉夹层患者手术后并发急性肾损伤(AKI)的高危因素。

方法

回顾性分析2012年6月至2016年12月山西医学科学院附属山西大医院78例因急性Stanford A型主动脉夹层行手术治疗患者的临床资料,依据2012年发布的改善全球肾脏病预后组织(KDIGO)指南中确立的诊断标准,按照术后是否发生AKl将78例患者分为AKI组和非AKI组,分析两组围手术期的各项指标,归纳总结术后并发AKI的相关危险因素。

结果

术后AKI发生率为57.7%(45/78例),住院死亡率为7.7%(6/78例),连续性肾脏替代治疗(CRRT)干预治疗率为46.2%(36/78例)。单因素分析示:术前肌酐水平(t=16.395,P<0.001)、体外循环时间(t=2.274,P=0.026)、深低温停循环时间(t=3.278,P=0.002)、术中输血量(t=16.448,P<0.001)、手术时间(t=3.703,P<0.001)、术后氧合指数≤100 mmHg(t=11.341,P<0.001)是术后发生AKI的危险因素;Logistic多因素分析示:术前肌酐水平(OR=11.364,95%CI:1.363~8.258,P=0.032)、术后氧合指数≤100 mmHg(OR=15.263,95%CI:1.152~7.382,P=0.043)是术后AKI的独立危险因素。

结论

术前肌酐水平、术后氧合指数≤100 mmHg是急性Stanford A型主动脉夹层患者术后AKI的独立危险因素。

Objective

To determine the risk factors of acute kidney injury (AKI) following type Stanford A Aortic Dissection (AD) operation.

Methods

We retrospectively analyzed the clinical data of 78 patients with Stanford A AD who underwent operation from Jun 2012 though Dec 2016. The patients were divided into AKI and non-AKI groups according to the KDIGO definition 2012. The risk factors of AKI were evaluated by comparing the clinical data of two groups.

Results

Of all included patients, 45(57.7%) patients developed to AKI and 36(46.2%) patients received renal replacement therapy (RRT). The hospital mortality was 7.7%. Univariate analysis revealed that preoperative creatinine (t=16.395, P<0.001), cardiopulmonary bypasstime (t=2.274, P=0.026), deep hypothermic circulatory arrest time (t=3.278, P=0.002), blood transfusion during operation (t=16.448, P<0.001), operation time (t=3.703, P<0.001), oxygenation index≤100 mmHg (t=11.341, P<0.001) postoperation were risk factors of AKI. Multivariate logistic analysis showed that preoperative creatinine(OR=11.364, 95%CI: 1.363~8.258, P=0.032) and oxygenation index≤100 mmHg (OR=15.263, 95%CI: 1.152~7.382, P=0.043) following-operation were independent risk factors for AKI.

Conclusion

Elevated preoperative creatinine level and oxygenation index≤100 mmHg following operation were independent risk factors of AKI in acute type A dissection surgery patients.

表1 AKI组与非AKI组患者一般临床资料比较
表2 AKI组与非AKI组患者围手术期指标的单因素分析结果
表3 78例主动脉夹层患者术后发生AKI危险因素的Logistic回归分析结果
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