心脏术后急性肾损伤的危险因素

Risk Factors of Acute Kidney Injury after Cardiac Surgery

目的探讨用急性肾损伤网络(acute kidney injury network,AKIN)标准诊断心脏术后AKI的危险因素.方法回顾性收集昆明医科大学第一附属医院心外科2012年6月至2013年6月期间所有行心脏手术的住院患者资料,根据AKIN诊断标准,对心脏术后AKI患者的发病率及危险因素进行统计学分析.结果 548例心脏手术患者中,用AKIN标准诊断心脏术后AKI的发生,其中81例发生AKI,发病率为14.78%,死亡患者3例;统计学分析表明:年龄、左室射血分数、高血压、术中甘露醇使用量、CPB时间、主动脉阻断时间、心脏停跳时间、机械通气时间、监护室停留时间、术前Scr、术前尿酸是心脏术后AKI发生的相关危险因素,而术前血肌酐(P<0.01)、年龄(P<0.01)、CPB时间(P<0.01)、机械通气时间(P=0.026)是心脏术后AKI发生的独立危险因素.结论 AKI是心脏手术后严重的并发症,术前血肌酐、年龄、CPB时间、机械通气时间是心脏术后AKI的独立危险因素.

Objective To explore the risk factors of acute kidney injury （AKI） after cardiac surgery according to the acute kidney injury network （AKIN） diagnosis standard. Methods The clinical data of patients underwent cardiac surgery in first affiliated hospital of Kunming Medical College were collected retrospectively from June 2012 to June 2013, and the incidence and risk factors of AKI after cardiac surgery were statistically analyzed according to AKIN standard. Results Among 548 patients, 81 cases had AK[ according the standard, with the incidence of 14.78%, and 3 patients were dead. Statistics analysis indicated that age, LVEF, hypertension, mannitol volume, CPB time, aortic cross-clamp time, cardiac arrest time, machinery ventilation time, intensive care unite stay time, preoperative UA, and preoperative serum creatinine （Scr） were significantly related to AKI after cardiac surgery. The preoperative Scr （P 〈 0.001） , age （P 〈 0.001） , CPB time （P 〈 0.001） , and machinery ventilation time （P = 0.026） were independent risk factors for post-operative AKI. Conclusion AKI is the serious complication after cardiac surgery, preoperative Scr, age, CPB time and mechanical ventilation time are independent risk factors for post-operative AKI.