术前肌酐增高患者心外术后急性肾损伤的药物影响因素

Medication factors for postoperative acute kidney injury in patients undergoing cardiac surgery and with elevated baseline serum creatinine

目的:分析术前肌酐增高患者行心外科手术后发生急性肾损伤(AKI)的药物影响因素。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例心外科手术患者术前肌酐增高患者124例。按照急性肾损伤网络组织(AKIN)制定的AKI诊断标准,将患者分为AKI和非AKI组,采用单因素比较和多因素Logistic回归分析方法,分析术前肌酐增高患者发生术后AKI的药物因素。结果:术前两组在一般情况如性别、年龄、体质量指数、合并糖尿病、高血压合并症的数目、心功能III^IV级、血清肌酐水平及评估的肾小球滤过率(e GFR)没有明显差别;两组的术中情况如手术方式、麻醉方式、手术持续时间、术中出血量、术中输液、输血量及术中尿量方面,也没有明显差别。术前及术后用药显示:AKI组术后静脉应用呋塞米的患者及静脉呋塞米单次剂量≥40mg的患者,明显多于非AKI组,而静脉应用多巴胺的患者明显少于非AKI组(P<0.01);二组术前血管紧张素转化酶抑制剂(ACEI)、血管紧张素Ⅱ受体阻断剂(ARB)等降压药物及他汀类降脂药物的应用没有明显差别。进一步Logistic回归分析显示:静脉应用呋塞米是术前肌酐升高患者心外手术后发生AKI的危险因素,而多巴胺则是心外手术后AKI的保护因素。结论:术后静脉用呋塞米是术前肌酐增高患者术后AKI的危险因素,静脉用多巴胺是术前肌酐增高患者术后AKI的保护因素。

Objective： To investigate the impact of medication on postoperative acute kidney injury（ AKI） in patients undergoing cardiac surgery and with elevated baseline serum creatinine（ Scr）. Methods：Baseline Scr of 1700 patients undergoing cardiac surgery in Beijing Anzhen Hospital from March 2008 to October 2008 were checked,and clinical data of 124 patients with elevated baseline scr were analyzed retrospectively. According to whether they got postoperative acute kidney injury（ AKI） by the Acute Kidney Injury Network（ AKIN） criteria,the patients were divided into AKI and Non-AKI groups,and pre and intraoperative risk factors,pre and postoperative medication were compared between AKI and Non-AKI groups using chi-square test or t-student test followed by multivariable Logistic regression analysis. Results： There were no significant differences in pre and intraoperative risk factors（ non-medication） between AKI and Non-AKI groups. There were more patients with intravenous furosemide postoperatively in AKI group（ 66%） than in Non-AKI group（ 38%）,but there were fewer patients with intravenous dopamine postoperatively in AKI group（ 77. 4%） than in Non-AKI group（ 94. 4%） significantly. Multivariate Logistic regression analysis revealed that intravenous furo-semide postoperatively was a risk factor（ OR： 5. 6; 95% CI： 1. 988,15. 777） and dopamine a protective factor（ OR： 0. 05; 95% CI： 0. 012,0. 257） for postoperative AKI in patients with elevated baseline Scr. Conclusion：In the patients with elevated baseline Scr,intravenous furosemide postoperatively is a risk factor and dopamine is a protective factor for AKI after cardiac surgery.