A型主动脉夹层术后行连续性肾脏替代治疗患者死亡危险因素分析

Analysis of mortality risk factors of continuous renal replacement treatment post type A aorta dissection surgery

目的:分析Stanford A型主动脉夹层患者深低温停循环(DHCA)手术后行连续性肾脏替代治疗(CRRT)的死亡危险因素。方法:回顾性研究2009年3月至2013年12月间,885例经DHCA下手术的A型主动脉夹层患者的临床资料,其中97例(10.96%)术后行CRRT治疗。CRRT治疗患者根据术后住院期间是否死亡分为:非死亡组(58例)及死亡组(39例),记录患者性别、年龄、相关病史、心功能、DHCA时间、出血量、输血量及术后并发症等临床资料,及CRRT前后SCr、乳酸、p H等数值,对术后死亡的相关危险因素进行单因素及多因素Logistic回归分析。结果:97例患者中住院死亡39例(40.21%),其中死于心力衰竭10例,多器官衰竭20例,多发性脑梗死4例,感染中毒性休克5例。单因素分析发现:年龄(P=0.011)、术前左心室舒末径(P=0.044)、术后急性呼吸功能不全(P=0.035)、术后低心排出量综合征(低心排)(P=0.012)、术后应用ECMO(P=0.037)、永久性神经功能障碍(P=0.025)、术后感染(P=0.012)、术后肢体缺血(P=0.047)、术后肝功能不全(P=0.045)、CRRT后血肌酐值(P=0.029)、CRRT前平均动脉压(P=0.016)、CRRT后平均动脉压(P=0.046)、CRRT后血乳酸值(P=0.014)及CRRT距离手术结束时间(P=0.032)是A型主动脉夹层手术后行CRRT治疗住院死亡的相关危险因素。多因素回归分析发现:术后低心排(P=0.028)、术后感染(P=0.037)、CRRT后血乳酸值(P=0.044)是其住院死亡的独立危险因素。结论:A型主动脉夹层手术后行CRRT治疗住院病死率较高,由多因素导致,应重视围术期脏器保护。

Objective： Analyzing mortality risk factors of continuous renal replacement treatment （CRRT） post deep hypothermia circulatory arrest （DHCA） surgery of Stanford Type A aorta dissection patients. Methods：Review clinical records of 885 Type A aorta dissection patients who were post DHCA surgery between March, 2009 and December, 2013. Among which there were 97 （10. 96% ）who underwent CRRT, compile patients＇ gender, age, medical history, cardiac function, DHCA duration, blood loss and transfusion volume, postoperative complications, as well as data of pre- and post-operative serum creatinine （SCr）, Lactate and pH, conduct single- and multi-factor logistic regression of postoperative mortality risk factors. Results：39 dead out of 97 patients, among which 10 dead of heart failure, 20 dead of multiple organ failure, 4 dead of multiple cerebral infarction, 5 dead of septic shock. Single factor analysis shows ： Age （ P = 0. 011 ） , preoperative left ventricnlar end diastolic diameter（ LVEDD, P = 0. 044 ） , acute respiratory dysfunction （ ARD, P = 0. 035 ） , postoperative low cardiac output （LCO, P = 0. 012） , postoperative extraeorporeal membrane oxygenation （EC- MO） application （P = 0. 037 ）, permanent neurological deficits （ P = 0. 025 ）, postoperative infection （ P =0. 012）, postoperative limb ischemia （ P = 0. 047 ）, postoperative hepatic insufficiency （ P = 0. 045 ）, post- CRRT SCr （P =0. 029） , pre-CRRT mean artery pressure （P =0. 016） , post-CRRT mean artery pressure （P =0. 046）, post-CRRT blood lactic acid value （P = 0. 014）, and time between surgery and CRRT （P = 0. 032） are in-hospital mortality risk factors of CRRT post DHCA surgery of Stanford type A aorta dissection pa- tients. Multi factor analysis shows ： postoperative LCO （ P = 0. 028 ）, postoperative infection （ P = 0. 037 ）, and post-CRRT blood laetic acid value （P = 0. 044） are independent in-hospital mortality risk factors thereof. Conclusion ： Many factors lead to high in-hospital mortality rate of CRRT post DHCA surgery of Type Aaorta dissection patients, attention must be paid to organ protection during perioperative period.