心脏手术后急性肾衰竭患者的病因和预后相关因素分析

Etiological and prognostic factors in patients with acute renal failure after cardiac surgery

目的探讨心脏手术后急性肾衰竭(ARF)的病因和影响预后的因素。方法回顾性分析108例心脏手术后ARF患者的临床资料,采用Cox逐步回归分析心脏手术后ARF影响预后的因素。结果引起ARF的主要原因有心源性低血压50例(46.3%),其他16例,42例病因不明。肾功能恢复47例(43.5%),患者存活38例(占35.2%),死亡70例,死亡的主要原因有多脏器功能不全(MODS)33例,心源性死因26例,其他11例。ForwardCox逐步回归分析提示:功能不全脏器数、少尿、持续低血压和是否透析与死亡明显相关。结论心源性低血压是心脏手术后ARF的主要病因,多数患者死于MODS和心脏并发症;功能不全的脏器多、少尿、持续性低血压和不透析预示死亡率增加;少尿患者及时透析可降低病死率。

Objective To evaluate etiological and prognostic factors contributing to acute renal failure (ARF) after cardiac surgery. Methods A retrospective study was carried out in patients with ARF after cardiac surgery. Cox regression analysis was performed to analyse prognostic factors. Results The contributing factors to ARF were cardiac hypotension (in 50 cases), hemolysis (in 8 cases), respiratory failure (in 4 cases), severe infection (in 3 cases), interstitial nephritis (in 1 case) and uncertain factors (in 42 cases). Renal function was recovered in 47 patients (43.5%), 38 patients survived (35.2%), 70 patients died (64.8%). The causes of death were as follow multiple organ dysfunction syndrome(MODS) (33 cases), heart failure (26 cases), respiratory failure(2 cases), hyperkalemia(4 cases), hemorrhage shock(2 cases), brain damage(1 cases), DIC (1 cases) and asphyxia (1 cases). Univariate analysis showed that the mortality rates were significantly higher in patients with oliguria(OR:10.4), persistent hypotension(OR:21.4), artificial ventilation more than 3 days(OR:18.3), coma (OR:9.4) and digestive tract bleeding (OR:4.11). To 76 oliguria patients, mortality rate was higher in non-dialysis group (Odds R=4.829, 95%CI: 1.002～23.275). Forward Stepwise Cox Regression analysis showed that persistent hypotension, oliguria, the number of impaired organs and non-dialysis were the most important factors correlated with death(P=0.010,0.00,0.034 and 0.01 respectively). Conclusion Persistent hypotension was the major cause of ARF following cardiac surgery. The majority of those patients died of MODS or heart complications. Oliguria, persistent hypotension, more impaired organs and non-dialysis were the strong prognostic factors of death. Early blood purification may ameliorate the prognosis of oliguria patients.