肺移植术后急性肾损伤的危险因素及预后分析

Analysis of risk factor for acute kidney injury after lung transplantation and its prognosis

目的观察肺移植术后急性肾损伤（acute kidney injury,AKI）的发生情况及预后,探讨肺移植术后发生AKI的危险因素。方法回顾性分析2002-2011年在原无锡第五人民医院及现无锡人民医院接受肺移植手术的成人患者术前、术中及术后临床资料,根据急性肾损伤网络（AKIN）标准诊断AKI。应用Logistic回归分析肺移植术后AKI发生的危险因素。结果术后有53.4%（47/88）患者发生AKI,其中AKI-1期占30.7%,AKI 2期占12.5%,AKI3期占10.2%;另其中3例接受肾脏替代治疗（3/47,6.4%）。多因素Logistic回归分析显示,术中失血量（OR=1.238）、术中平均动脉压差（△MAP）（OR=3.221）是肺移植术后发生1期AKI的独立危险因素;术前蛋白尿（OR=3.185）、术中红细胞（RBC）输注量（OR=1.653）、术前高血压史（OR=2.285）是肺移植术后发生2-3期AKI的独立危险因素;术中ECOM支持（OR=0.113）是术后发生2-3期AKI的保护性因素。结论肺移植患者术后AKI发生率高,AKI患者预后较差。关注AKI的发生的危险因素可能有助于预防肺移植术后AKI的发生,改善患者预后。

Objective To determine the incidence, risk factor and outcome of acute kidney injury （AKI） after lung transplantation （LT）. Methods Clinical data of adult patients undergone LT were retrospectively analyzed. Acute Kidney Injury Net （AKIN） criteria were applied to define and classify the postoperative AKI. Logistic regression analysis was used to determine the risk factor for AKI. Results Of the 88 patients in the period of investigation, 47 patients （53.4%） presented AKI. The percentage of stage I, stage II, and stage III AK/was 30.7%, 12.5%, and 10.2%, respectively. Three patients with AKI （6.4%） needed renal replacement therapy. Multivariate logistic regression analysis showed that intraoperative blood loss （OR=1.238） and change of mean artery pressure （OR=3.221） were the independent risk factors for stage I AKI. Preoperative proteinuria （OR=3.185）, RBC transfusion during operation （OR=1.653）, and hypertension （OR=2.285） were the independent risk factors for stage II and stage III AKI. The support of ECOM （OR=0.113） was a protect factor for AKI. Conclusions The incidence of AKI after LT is quite high and the prognosis is poor. We should pay more attention to the potential risk factors for AKI to improve the prognosis of LT patients.