心脏多瓣膜置换术后患者急性肾损伤发生情况及预后危险因素分析

Incidence of acute kidney injury and risk factors of prognosis in patients after heart multiple valve replacement

目的分析心脏多瓣膜置换术后患者急性肾损伤(AKI)发生情况及预后危险因素。方法选取2013年7月至2014年5月首都医科大学附属北京安贞医院行体外循环下心脏多瓣膜置换术的1 140例患者为研究对象。记录收集患者围术期相关临床资料,所有患者均进行电话随访,主要终点为病死率,次要研究终点为AKI发生率。采用Kaplan-Meier和Log-Rank检验分析AKI对预后的影响,采用多因素Cox回归模型分析术后患者死亡的危险因素。结果 278例患者发生AKI,发生率为24.4%。平均随访时间(10±3)个月,34例患者死亡,病死率为3.0%。发生AKI患者的病死率明显高于无AKI患者[5. 8%(16/278)比2.1%(18/862)](P=0.002)。术后发生AKI使患者的病死率增加近1倍(相对危险度=1. 910,95%置信区间:1.010～3.160,P=0.003);此外,术前合并冠状动脉粥样硬化性心脏病、术中主动脉阻断时间长、输入血浆多和术后机械通气时间长均是心脏多瓣膜置换术后患者死亡的独立危险因素(均P <0.05)。结论心脏多瓣膜置换术后患者AKI发生率较高,发生AKI是患者死亡的独立危险因素。

Objective To investigate the incidence of acute kidney injury（AKI） and the risk factors of prognosis in patients after multiple valve replacement. Methods A total of 1 140 patients who underwent multiple valve replacement in Beijing Anzhen Hospital, Capital Medical University from July 2013 to May 2014 were included. Perioperative records and follow-up data were analyzed. The main end-point was death. The secondary end-point was AKI. Relation between AKI and postoperative outcome was analyzed by Kaplan-Meier test and Log-Rank test. Risk factors of death were analyzed by multivariate Cox regression. Results Incidence of AKI in 1 140 patients was 24.4%（n=278）. All patients were followed up for （10±3）months and the death rate was 3.0%（n=34）. Death rate in AKI patients was significantly higher than that in non-AKI patients[5.8%（16/278） vs 2.1%（18/862）]（P=0.002）. Cox regression analysis showed that the death rate in AKI patients was nearly doubled compared to that in non-AKI patients（relative risk=1.910, 95% confidence interval： 1.010-3.160, P=0.003）. Coronary heart disease, prolonged aortic clamp, plasma infusion and prolonged postoperative mechanical ventilation were also independent risk factors of death in patients after multiple valve replacement（all P〈0.05）. Conclusion Patients with multiple valve replacement have a high incidence of postoperative AKI, which is an independent risk factor of death.