心脏外科术后肾脏替代治疗预后影响因素分析

Factors affecting prognosis of the patients with renal replacement therapy after cardiac surgery

目的 研究心脏外科术后肾脏替代治疗患者资料,分析影响其预后的危险因素. 方法 回顾性分析阜外医院2011年5月～2014年10月期间第二成人外科恢复室收治的心脏外科术后肾脏替代治疗患者资料,包括患者一般资料、基础疾病、手术类型及体外循环时间,术中及术后各项临床指标.终点指标包括机械通气时间、ICU治疗时间、死亡人数、围术期并发症发生率. 结果 全组216名患者死亡68例,死亡率31.5％.死亡率最高为冠脉搭桥联合瓣膜置换术死亡32人,死亡率56.1％（32/57）;心脏移植术后死亡5例,死亡35.7％（5/15）;冠脉搭桥术后死亡23人,死亡率28.0％（23/82）;瓣膜置换术死亡7人,死亡率15.2％（7/46）;先心病矫治术死亡1例,死亡率9.1％（1/11）.术前心功能分级、术中低血压、术后低心排综合征及体外膜氧合（ECMO）辅助是心脏术后肾脏替代治疗患者死亡的重要危险因素.住院期间肾功能恢复者73例（33.8％）,转为慢性肾功能不全需要长期血液透析者41例（18.9％）.术前基础血肌酐水平、术中低血压、二次开胸探查、多尿期出现时间是肾功能恢复的重要危险因素.结论 心脏外科术后肾脏替代治疗患者死亡率高、与围术期多种危险因素密切相关.

Objective To explore the risk factors affecting prognosis of the patients with renal replace- ment therapy after cardiac surgery. Methods We retrospectively analyzed the clinical data of the patients with renal replacement therapy after cardiac surgery treated in Adult Surgery ICU of Fuwai Hospital in the pe- riod from May 2011 to Oct. 2014. Results The mortality rate was 31.5% （68/216）. Coronary artery bypass grafting （CABG） combined with valve surgery had the highest mortality rate （56.1%）, followed by cardiac transplantation （35.7%）, CABG （28.0%）, and valve surgery （15.2%）. Multivariate logistic regression analyses showed that basic cardiac function, intra-operative hypotension, low cardiac output syndrome after surgery, and extracorporeal membrane oxygenation （ECMO） were the risk factors for death in renal replacement thera- py patients after cardiac surgery. Renal injury recovered in 33.8% patients, and progressed to chronic renal dis- ease in 18.9% patients. Baseline level of serum creatinine, intra-operative hypotension, re-operation, and the recovery period of urinary output were the important risk factors for recovery from acute renal injury. Con- clusion The mortality in renal replacement therapy patients after cardiac surgery was high, and was closely related to many risk factors in the peri-operative period.