肌酐增高患者对心外科手术后急性肾损伤的影响

The impact of increased preoperative serum creatinine on acute kidney injury following cardiac surgery

目的:探讨心外科手术患者术前肌酐升高对于术后急性肾损伤(AKI)发生及恢复的影响。方法:回顾性分析首都医科大学附属北京安贞医院,2008年3月至2008年10月,1 700例心外科手术患者,根据术前肌酐水平将患者分为术前肌酐正常组及术前肌酐增高组,按照急性肾损伤网络组织(AKIN)制定的AKI诊断标准,筛选出AKI患者,分析术前肌酐水平对AKI发生及恢复的影响。结果:1 700例心外科手术患者术后发生AKI 264例(15.5%);术前肌酐水平增高的患者较术前肌酐水平正常的患者其术后AKI的发生率明显增高(44.2%vs.12.4%,P<0.01);术前肌酐水平和年龄是术前肌酐增高组患者术后AKI发生率高于术前肌酐正常组患者的主要因素;术前肌酐正常患者合并糖尿病或高血压不增加AKI的发生(P>0.05),但是术前肌酐增高患者合并糖尿病或高血压增加AKI的发生率(P<0.05);术前肌酐增高患者术后AKI在7天内恢复率明显低于术前肌酐正常患者。结论:心外科手术患者术前肌酐升高不仅增加术后AKI发生率,也增大合并糖尿病或高血压患者发生AKI的风险性,且发生的AKI较难在短期内恢复。

Objective： To investigate the impact of elevated preoperative Scr on the prevalence and 7-day-recovery rate of acute kidney injury（ AKI） following cardiac surgery. Methods： Clinical data of 1 700 patients undergoing cardiac surgery in Beijing Anzhen Hospital from March 2008 to October 2008 were analyzed retrospectively. According to preoperative Scr level,the patients were divided into the normal Scr and the elevated Scr group. Postoperative AKI was defined,using the Acute Kidney Injury Network（ AKIN） criteria. The prevalence and the recovery of postoperative AKI,as well as the risk factors were compared between AKI patients with normal and elevated preoperative Scr level,using chi-square test and multivariable logistic regression analyses. Results： Out of the 1700 patients studied,264（ 15. 5%） had postoperative AKI,and 191 patients（ 12. 4%） were from normal Scr group（ n = 1 535） and 73 patients（ 44. 2%） were from elevated Scr group（ n = 165）. The prevalence of the postoperative AKI increased significantly in the elevated Scr group compared to the normal Scr group（ P〈0. 05）,and the main factors leading to this difference are elevated preoperative Scr and older age; In the elevated preoperative Scr group,combination with diabetes mellitus or hypertension increased the prevalence of the postoperative AKI（ P〈0. 05）; Patients recovered from AKI in 7 days（ the peak postoperative Scr level went back to the preoperative Scr level） were more in the normal preoperative Scr group than in the elevated preoperative Scr group. Conclusion： In this population,elevated preoperative Scr level not only increase the prevalence of postoperative AKI in patients undergoing cardiac surgery,but also make the postoperative AKI difficult to recover in a shorter time.