心脏手术后需要肾替代治疗患者围手术期危险因素分析

Perioperative factors for the requirement of renal replacement therapy following cardiac surgery

目的研究心脏手术后急性肾损伤(cardiac surgery associated acute kidney injury,CSA-AKI)需要肾替代的发生率以及相关的危险因素。方法回顾性分析我院2012年07月~2015年12月所有进行心脏手术排除己进行血液透析患者的资料,包括患者的一般资料、合并疾病以及用药情况,术中红细胞输注、体外循环时间、机械通气时间,术后各项临床指标、使用的药物等。结果剔除资料不全者后共2810例患者入选,发生急性肾损伤者(acute kidney injury,AKI)982例(34.95%),需要肾替代治疗者为33例(1.17%),医院内死亡25例(0.89%),logistic回归分析显示心脏术后需要肾替代与女性(OR=0.323,95%CI 0.142~0.734,P=0.007)、更低的体质量指数(body mass index,BMI)(OR=0.902,95%CI=0.813~1.001,P=0.053)、术前有慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)(OR=7.597,95%CI=1.868~30.902,P=0.005)、慢性肾脏病病史(OR=7.782,95%CI=2.551~23.735,P<0.001)、射血分数降低(OR=0.961,95%CI=0.930~0.994,P=0.019)、术中输注更多的红细胞(OR=1.121,95%CI=1.075~1.170,P<0.001)、术后体温超过38℃(OR=3.345,95%CI=1.449~7.723,P=0.005)等有关。结论心脏手术后需要肾替代治疗与围手术期多种因素相关。

Objectives To explore the risk factors for the cardiac surgery associated acute kidney injury （CSA-AKI） that needs renal replacement therapy （RRT） after cardiac surgery. Methods We retrospectively analyzed the clinical data of the patients with RRT after cardiac surgery treated in Nanjing First Hospital in the period from Jun. 2008 to Dec. 2012. Results A total of 2,810 consecutive patients who underwent cardiovascular surgery from 2008 to 2012 at the single institution were reviewed. Acute kidney injury was found in 982 （34.9%） patients, of which 33 patients （1.17%） required RRT and 25 patients died （0.089%） in hospital. Multivariate logistic regression showed that female （P=0.007, OR=0.323, 95% CI 0. 142-0.734）, lower BMI （P=0.053, OR=0.902, 95% CI 0.813~1.001）, COPD history （P=0.005, 0R=7.597, 95% C1 1.868-30.902）, CKD history （P〈0.001, OR=7.782, 95% CI=2.551-23.735）, lower left ventricular ejection fraction （P=- 0.019, OR=0.961, 95% CI=0.930-0.994）, more red cell transfusion during operation （P〈0.001, OR=1.121, 95% CI 1.075-1.170） and postoperative fever over 38℃ （P=-0.005, OR=3.345, 95% C1 1.449-7.723） were the risk factors for RRT after cardiac surgery. Receiver-operating characteristic curve analysis showed that the area under the curve was 0.8512. Conclusion The need for RRT after cardiac surgery was relatively high, and was closely related to several risk factors in the perioperative period.