急性Stanford A型主动脉夹层术后急性肾功能损伤的危险因素分析

Predictive risk factors for acute kidney injury after surgery for Stanford type A acute aortic dissection

目的分析急性Stanford A型主动脉夹层术后急性肾功能损伤(AKI)的危险因素。方法回顾性分析青岛市市立医院2010年9月至2017年9月间220例Stanford A型主动脉夹层手术患者的资料。平均年龄(52.3±8.7)岁,男162例(73.6%)、女58例(26.4%)。按患者术后是否发生AKI分2组:发生AKI者40例(A组),其中男29例、女11例,平均年龄(54.6±9.2)岁;未发生AKI者180例(B组),男133例、女47例,平均年龄(48.5±7.9)岁。对两组患者围术期多项指标进行单因素和多因素分析。结果住院死亡12例(5.5%),发生AKI组患者死亡7例(17.5%),未发生AKI组患者死亡5例(2.8%)。单因素分析显示,两组患者年龄、术前血清肌酐值、术前白细胞水平、欧洲心血管手术危险因素评分、体外循环时间、深低温停循环(DHCA)时间、主动脉根部处理、主动脉弓置换、术中及术后24 h输注红细胞量、术后机械通气时间、ICU滞留时间、住院时间、院内死亡率等方面差异有统计学意义。多因素分析显示,术前血清肌酐值、术前白细胞水平、体外循环时间和术中及术后24 h输注红细胞量是术后AKI的独立危险因素。结论术前血清肌酐值、术前白细胞水平、体外循环时间和术中及术后24 h输注红细胞量是急性Stanford A型主动脉夹层术后急性肾功能损伤的独立危险因素。临床上可以根据上述危险因素采取相应的预防措施,保护肾脏功能,降低围术期死亡率。

Objective To identify the predictors of postoperative acute kidney injury in patients undergoing surgery for Stanford type A acute aortic dissection.Methods A total of 220 patients who underwent surgery for type A acute aortic dissection in Qingdao Municipal Hospital from September 2010 to September 2017 were divided into two groups including a group A and a group B based on whether acute kidney injury occurred or not after surgery.There were 40patients with 29 males and 11 females with the mean age of 54.6±9.2 years in the group A,180 patients with 133 males and 47 females with the mean age of 48.5±7.9 years in the group B.Univariate and multivariate analyses (logistic regression)were used to identify the predictive risk factors.Results Overall in-hospital mortality was 5.5%.In univariate analysis,there were statistically significant differences with respect to the age,preoperative creatinine,preoperative white blood cell,the European system for cardiac operative risk evaluation (EuroSCORE),total cardiopulmonary bypass (CPB) time,deep hypothermic circulatory arrest (DHCA)time,arch replacement,red blood cell transfusion intraoperative and in 24 hours postoperatively,postoperative mechanical ventilation time,ICU stay duration,hospital stay duration and in hospital mortality.Multivariate logistic analysis showed that preoperative creatinine,preoperative white blood cell,CPB time,and red blood cell transfusion intraoperative and in 24 hours postoperatively were the independent predictors for postoperative acute kidney injury.Conclusion The incidence of acute kidney injury is high after surgery for acute Stanford type A aortic dissection.It can be predicted based on above factors,for patients with these risk factors,more perioperative care strategies are needed in order to induce the incidence of acute kidney injury.