心脏术后发生急性肾功能衰竭的危险因素

Risk factors associated with acute renal failure(ARF)in patients after cardiac surgery

目的分析心脏手术后发生急性肾功能衰竭(ARF)的危险因素。方法选择1994至2002年间心脏手术后发生ARF的患者108例,同期未发生ARF的患者152例为对照组。结果ARF组术前肌酐清除率(CCr)和左室射血分数都显著低于对照组(P＜0．01),体外循环时间、心脏停跳时间、手术总时间显著长于对照组(P＜0．01,P＜0．05,P＜0．01),术中输血量显著多于对照组(P＜0．01)。逐步Logistic回归分析提示术前NYHA心功能分级、基础CCr、术后低血压、术后再次开胸和心脏手术时间可预示心脏术后是否发生ARF,OR分别为3．04、0．97、9．66、11．61、1．32。结论术前心力衰竭、基础CCr降低、术后低血压、再次开胸术及手术时间延长是心脏术后发生ARF的重要危险因素。

Objective To study risk factors associated with ARF in patients after cardiac surgery. Methods A retrospective cases control study was carried out in patients who underwent cardiac surgery from 1994 to 2002 in our hospital, with 108 patients in ARF group and 152 patients without ARF as control group. Perioperative variables were analyzed by univariate and logistic regression. Results Compared with control group, patients in ARF group had lower creatinine clearance rate （CCr） [ （65.2 ± 26.7） ml/min vs （91.4 ± 28.1 ） ml/min, P 〈 0.01 ], lower ejection fraction [ （0.54±0.09） vs （0.58±0.07）, P〈0.01], longer cardiopulmonary bypass （CPB） time [ （145.8±111） min vs （99.9±46.0） min, P〈0.01] and surgery duration [ （6.1±3.5） h vs （3.9± 1.5） h, P〈0.01], more blood transfusion [ （ 1 360 ± 1 076） ml vs （847 ± 400） ml, P 〈 0.01 ]. There were no difference on perfusion pressure, mean perfusion flow rate and mannitol infusion during CPB between the two groups. Forward stepwise logistic regression showed that heart NYHA class states, baseline CCr, postoperative lower blood pressure, reoperation and duration of surgery were the significant risk factors associated with ARF in those patients （ OR： 3.04, 0.97, 9.66, 11.61, 1.32）. Conclusion The preoperative chronic heart failure, reduced baseline CCr, postoperative lower blood pressure, reoperatiun and prolonged duration of surgery are the significant risk factors associated with ARF in patients after cardiac surgery.