腹主动脉瘤术后并发急性肾损伤的危险因素及短期预后分析

Risk factors and short-term prognosis of acute kidney injury after abdominal aortic aneurysm surgery

目的探讨腹主动脉瘤(AAA)患者术后并发急性肾损伤(AKI)的临床特点、危险因素及短期预后。方法收集住院接受手术治疗的314例AAA患者的临床资料、手术记录及实验室检查结果,分析AAA患者术后并发AKI的临床特点、危险因素及短期预后。结果 314例AAA患者中,术后并发AKI 94例(29.9%)。有心血管疾病史、基础GFR降低、手术时间长及术中出血量>1 L为AAA患者发生AKI的危险因素(P均<0.01)。与非AKI患者相比,AKI患者术后使用血管活性药物以及机械通气支持比例升高,同时术后ICU住院时间、术后住院时间及总住院时间均延长(P均<0.01),住院期间病死率升高(13.8%vs.3.2%,P<0.01)。结论 AAA术后AKI发生率高,有心血管疾病史、基础GFR降低、手术时间长、术中出血量>1 L是AAA术后合并AKI的危险因素。术后合并AKI将延长患者住院时间、增加医院内病死率。

Objective To investigate the clinical characteristics,risk factors and short-term progno-sis of acute kidney injury （AKI） after abdominal aortic aneurysm （AAA） surgery. Methods The clinical, surgical and laboratory data of 314 patients diagnosed with AAA were collected to analyze the clinical character-istics, risk factors and short-term prognosis of AKI following surgery. Results Among 314 AAA patients, 94 （29.9%） were complicated with AKI after surgery. History of cardiovascular diseases, decreased baseline GFR, longer operative time and intraoperative blood loss 〉 1 L were the risk factors of AKI after surgery （all P 〈0. 01）. Compared with non-AKI patients, the proportion of use of vasoactive medications and mechanical ventilation was significantly elevated （ all P 〈 0. 01） , the ICU stay, postoperative and total hospital stay were considerably prolonged （ all P 〈 0. 01） , and the mortality rate during hospitalization was significantly enhanced （13. 8% vs. 3. 2% , P 〈0. 01） in AKI patients. Conclusions The incidence of AKI after AAA surgery is relatively high. History of cardiovascular diseases, decreased baseline GFR, longer operative time and intraoperative blood loss 〉 1 L are the risk factors for AKI complication after surgery. Postoperative AKI complication is likely to prolong hospital stay and increase mortality rate during hospitalization.