再次心脏瓣膜置换术后急性肾功能衰竭的危险因素分析

Clinical analysis the risk factors associated with acute renal failure in redo cardiac valve surgery

目的:探讨再次心脏瓣膜置换术后急性肾功能衰竭发生的危险因素。方法:回顾272例再次心脏瓣膜置换术患者的临床基本情况、术前肾功能、手术方式、体外循环参数等相关临床资料,通过多因素Logistic回顾分析术后发生急性肾功能损伤的危险因素。结果:272例患者中术后发生急性肾功能衰竭12例。多因素logistic回归分析显示术前合并其他系统疾病(OR=9.104,P=0.029)、急诊手术(OR=90.998,P=0.000)、女性患者(OR=46.449,P=0.016)、术前左心室内径>60mm(OR=0.114,P=0.041)是导致患者术后急性肾功能衰竭发生的危险因素。结论:急性肾功能衰竭是再次心脏瓣膜术后最危险的并发症之一,术前积极治疗患者其他系统疾病、选择合理的手术时机,术中尽量缩短体外循环转流时间,术后加强对患者肾功能变化的监测有助于降低肾功能衰竭的发生率。

Objective：To investigate the risk factors associated with acute renal failure in redo cardiac valve surgery.Method：We retrospective analyzed the clinical data of the patients who received redo cardiac valve surgery from December 2007 to October 2014 in Xinqiao Hospital of Third Military Medical University.Preoperative renal function,surgical approach,cardiopulmonary bypass time and basic clinical characteristic of the patients were collected in this study.Multivariate logistic regression was used to analyze the risk factors associated with acute renal failure in patients undergoing redone cardiac valve surgery.Result：Two hundred and seventy-two patients were included in the study,12 patients had got acute renal failure after redo cardiac valve surgery.Multivariate logistic regression showed that patients with other system diseases（OR=9.104,P=0.029）,female（OR=46.449,P=0.016）,emergency surgery（OR=90.998,P=0.000）,left ventricular diastolic dimension（OR=0.114,P=0.041）were independent risk factors of acute renal failure in patients underwent redo heart valve surgery.Conclusion：Acute renal failure is a common and one of the most dangerous complications in patients underwent redo cardiac valve surgery.To decrease the incidence of acute renal failure in these patients,it maybe helpful to treat other systemic disease actively,choose the appropriate operation occasion,shorten the cardiopulmonary bypass time and supervise the renal function routinely after cardiac surgery.