心脏瓣膜手术后并发透析依赖的急性肾功能衰竭的危险因素

Analyzing the risk factors for the postoperative acute renal failure requiring dialysis after valve surgery

目的 探讨心脏瓣膜手术后并发透析依赖的急性肾功能衰竭（acute renal failure requiringdialysis,ARF-D）的危险因素.方法 回顾性分析2005年1月至2008年12月心脏瓣膜手术、年龄≥18岁、术前血肌酐＜300 μmol/L的病例资料.术后30天内并发ARF-D者为病例组,共55例.随机抽取同期未并发ARF-D的220例作为对照组.采用单因素分析及多因素Logistic回归探讨并发ARF-D的危险因素.结果 心脏瓣膜术后ARF-D发生率为1.78%,早期病死率65.5%.Logistic回归分析结果显示年龄、二次手术、术前血肌酐、心功能（NYHA）Ⅳ级、术后低心排血量综合征为心脏瓣膜术后并发ARF-D的独立危险因素.病例组与对照组相比,监护室停留时间、术后住院时间差异有统计学意义（P＜0.05）.结论 年龄、二次手术、术前血肌酐、心功能Ⅳ级、术后低心排血量综合征为心脏瓣膜术后并发ARF-D的独立危险因素.

Objective To evaluate the risk factors for the postoperative acute renal failure requiring dialysis （ARF-D）after heart valve surgery. Methods Adult patients （age≤18 years） underwent valve surgery with preoperative serum creatinine 〈300 μmol/L were included between January 2005 and December 2008. Fifty patients developed ARF-D within 30 days postoperatively （ARF-D group）. While random 220 patients had the same operation without ARF-D served as the control group. Univariate analysis and multivariable logistic regression were used to identify risk factors of ARF-D after valve surgery.Results The incidence of ARF-D was 1.78%, and the early mortality rate was 65.5%. Multivariate analysis identified the following independent risk factors of ARF-D： age, previous cardiac surgery, preoperative serum creatinine, NYHA class Ⅳ,and low cardiac output syndrome. ARF-D group had a longer hospital stay and ICU stay than that of the control group （ P 〈0.001 ）. Conclusion Conclusion ARF-D had a higher mortality rate and longer hospital stay following heart valve surgery.Age, previous cardiac surgery, preoperative serum creatinine, NYHA class Ⅳ, and low cardiac output syndrome were the independent risk factors of ARF-D after heart valve surgery.