急性主动脉夹层术后急性肾衰竭5年生存率分析

Midterm outcomes following acute kidney failure after surgery for acute type A aortic dissection

目的 分析中低温停循环（鼻咽温21℃～ 25℃）的急性主动脉夹层术后急性肾衰竭（acute kidney failure,AKF）患者死亡原因和5年生存率,探讨AKF患者中期死亡的影响因素.方法 2009年2月至2015年3月在我院行急诊主动脉夹层手术的患者,术前肾脏替代治疗者除外,记录年龄、性别、心血管疾病史、术前血肌酐和术中体外循环情况.根据AKF定义为术后肾功能恶化,需要肾脏替代治疗.分AKF组并出院后进行电话随访.Kaplan-Meier曲线进行生存率分析,Cox回归法分析中期死亡的危险因素.结果 524例急性主动脉夹层患者入选,术后51例发生AKF,发生率9.7％ （51/524）.平均随访30.5个月.术后30天AKF患者12例死亡,病死率23.5％（12/51）,死亡原因7例脑血管病变（58.3％,7/12）,3例下肢缺血（25％,3/12）和2例低心排血量综合征（16.7％,2/12）.术后1年死亡2例,1例多脏器功能衰竭,1例截瘫肺部感染.术后5年因远端吻合口漏二次手术死亡1例.Cox回归显示糖尿病增加AKF患者中期死亡风险（OR 8.26,P=0.01）.AKF患者总体5年生存率56％,根据术前血肌酐≥200 mol/L和血肌酐＜200mol/L分两组进行比较,5年生存率差异无统计学意义（50％对57％,P＞0.05）.结论 急性主动脉夹层术后AKF发生率9.7％.AKF术后5年生存率56％,术前血肌酐水平不影响5年生存率.糖尿病增加中期死亡风险.

Objective This study aims to analyze midterm survival and to assess the midterm mortality following acute kidney failure （AKF） of patients undergoing surgical treatment of acute type A aortic dissection.Methods Clinical data of the patients who underwent Sun＇s procedure from February 2009 to March 2015 were collected.Patients with preoperative dialysis were excluded.Data including preoperative cardiovascular diseases,serum creatinine leve1 and CPB time were gathered.The patients were divided into the group of AKF and the group of non-AKF accounting to require dialysis.The group of AKF was follow-up by phone.Midterm mortality was studied with Cox analysis and midterm survival was estimated by Kaplan-Meier analysis.Results 524 patients underwent aortic surgeries which AKF was occurred in 51 （51/524,9.7％） patients.Hospital mortality was 23.5％ （12/51） in AKF group which seven death were strokes,three death were lower-extremity ischemia and two death were low cardio output.There were 2 patients dead with multi organ failure and paraplegia in first year.One reoperation patient because of anastomotic fistula was dead in fifth year.Only diabetes was independently associated with midterm mortality.Midterm survival for patients with AKF was 56％ during a median follow-up of 30.5 months.Survival was equal between the subgroups of Cr ＞ 200 mol/L and Cr ＜ 200 mol/L（P =0.741）.Conclusion AKF after acute aortic dissection was a severe complication and the incidence was 9.7％.In patients with AKF,diabetes was associated with increased mortality across follow-up.Five years survival was 56％ not effected by preoperative Cr.