血管外科手术后发生急性肾损伤的危险因素分析

The risk factors of acute kidney injury following vascular surgeries

目的探讨血管外科手术后急性肾损伤(acute kidney injury,AKI)发生的危险因素。方法回顾性分析2011年血管外科住院患者的临床、手术及实验室检查资料,计算AKI发病率和慢性肾脏病(chronic kidney disease,CKD)的患病率,并用Logistic回归分析AKI发生的危险因素。结果术后共发生AKI为54例(4.1%),发生在主动脉夹层瘤16例(26.2%)、急性肢体动脉栓塞10例(17.5%)、动脉狭窄/栓塞15例(3.3%),发生AKI的患者中死亡9例(16.7%)。术前CKD的实际患病率为17%(397例),而术前提供肾脏病史的仅有5.7%(133例)。使用造影剂、CKD病史、术中低血压、发生多脏器功能衰竭(multiple organ dysfunction syndrome,MODS)与术后AKI的发生显著相关。Logistic回归分析显示,合并上述四个危险因素患者发生AKI的风险分别增加1.149、2.432、5.126和6.645倍(P<0.05)。结论血管外科手术后AKI的发生率较高,特别是主动脉夹层瘤和动脉栓塞疾病。既往有CKD病史、术中低血压和发生MODS是AKI发生和患者死亡的主要危险因素。因此,需重视对CKD的术前诊断和评估,并加强围手术期肾功能的观察和保护,及早发现和干预AKI的进展,有助于改善AKI的预后。

Objective To evaluate the incidence of acute kidney injury and its risk factors after vascular surgery. Method The clinical, surgery and laboratory data of 1,332 patients undergoing vascular surgery in the year of 2011 were collected from electronic medical records and retrospectively reviewed. Result Fifty-four （4.1%） of 1332 patients developed AKI after the surgery, including 16/61 aortic aneurysm, 10/57 acute limb arterial embolism, and 15/451 arterial stenosis/embolism. Nine of the 54 AKI patients （16.7%） died. The morbidity of chronic kidney disease （CKD） before the surgery was 17%. Logistic regression analysis revealed that radio-contrast media, a history of CKD, intraoperative hypotension and multiple organ dysfunction syndrome （MODS） were the risk factor of AKI （OR=1.149, 2.432, 5.126 and 6.645, respectively; P〈0.05）. Conclusion Higher morbidity of AKI was found after vascular surgery, especially after aortic aneurysm and acute arterial embolism. A history of CKD, intraoperative hypotension and MODS were the major risk factors of AKI. Therefore, we should pay attention to the presence of CKD before surgery and changes of renal function after the surgery, to facilitate early diagnosis and appropriate treatment of AKI.