体外循环心脏手术后早期急性肾损伤的临床分析

Acute kidney injury early after cardiac surgery with cardiopulmonary bypass： clinical analysis

目的研究体外循环（CPB）心脏手术后早期急性肾损伤（AKI）的发生，探讨其围手术期危险因素及其对临床结果的影响。方法收集2008年1月至2011年4月解放军总医院心血管外科接受CPB心脏手术的成年病例资料共1472例，采用RIFLE标准进行分级诊断，观察术后AKI的发生及其对临床结果的影响，分析其围手术期危险因素。结果术后72h内发生AKI437例（29．7％），其中AKI风险期292例（19．8％），损伤期110例（7．5％），衰竭期35例（2．4％）。年龄、高血压、慢性肾功能不全、二次手术、主动脉手术、CPB时间、术中输红细胞量和围手术期应用主动脉内球囊反搏等是AKI发生的独立危险因素。术后机械通气时间、延迟通气和拔管失败发生率、ICU停留时间、术后住院时间和病死率等随AKI严重程度分级增加而递增。ROC曲线提示AKI分级对于术后延迟通气、拔管失败和死亡具有预测意义。结论AKI是CPB心脏手术后早期的常见并发症，其发生与围手术期多种危险因素有关；AKI严重程度是术后延迟通气、拔管失败和死亡的预测因子。

Objective To explore the occurrence of acute kidney injury （AKI） in early stage after cardiac surgery under cardiopulmonary bypass （CPB） and discuss the perioperative risk factors and its impact on clinical outcome. Methods Retrospective analysis was performed among 1472 adult patients undergoing cardiac surgery with CPB between January 2008 and April 2011. The postoperative occurrence of AKI following cardiac surgery was stratified according to the RIFLE criteria. And the perioperative risk factors of AKI and its impact on clinical outcome were analyzed. Results AKI occurred in 437 patients （29.7%） within 72 hours postoperation. Of these, 292 （ 19.8% ） fulfilled AKI-Risk, 110 （7.5%） AKI- Injury and 35 （2.4%） AKI-Failure. Logistic regression analysis showed that age, hypertension, chronic renal insufficiency, reoperation, aortic surgery, CPB duration, intraoperative transfused erythrocyte volume and perioperative use of intra-aortic balloon pump were independent risk factors for AKI. A postoperative elevation of AKI level was associated with a prolonged duration of mechanical ventilation, intensive care unit stay, postoperative hospital stay, delayed extubation, extubation failure and death. Receiver operator characteristic （ROC） curve showed that AKI classification was a postoperative predictor of delayed extubation, extubation failure and death. Conclusion As a common complication after cardiac surgery, AKI is associated with many perioperative risk factors. And the AKI classification is predicator of delayed extubation, extubation failure and death.