急性A型主动脉夹层行孙氏手术术后急性肾损伤需持续血液透析治疗相关风险因素分析

Predictors of postoperative severe acute kidney injury requiring continuous renal replacement treatment in patients with acute A aortic dissection undergoing Sun' s operation

目的探讨急性A型主动脉夹层行孙氏手术术后出现严重急性肾损伤(AKI)需持续肾脏替代治疗(CRRT)的发生率及危险因素。方法回顾性分析2009年1月至2015年12月首都医科大学附属北京安贞医院大血管疾病中心连续收治的683例急性A型主动脉夹层行孙氏手术患者临床资料,根据术后是否出现严重AKI需CRRT治疗分为透析组(AG,65例)和对照组(CG,618例),比较两组患者临床预后并分析相关风险因素。结果 683例中50例(7.3%)住院死亡。与CG组患者相比较,AG组患者年龄较高、术前合并冠心病或心包压塞者较多、术中行冠状动脉旁路移植或瓣膜手术者比例均较高,差异均有统计学意义(P<0.05)。AG组住院死亡比例较高(26.2%对5.3%),差异有统计学意义(P<0.001)。多元回归分析结果提示年龄>50岁、术前心包压塞史、术中需联合冠状动脉旁路移植术或瓣膜手术、脑灌注时间>40 min是术后严重AKI需CRRT治疗独立风险因素(P<0.05)。结论急性A型主动脉夹层孙氏手术术后严重AKI需CRRT治疗发生率为9.5%,出院生存率较低。尽可能缩短术中脑灌注时间可能是降低术后严重AKI发生率的重要途径。

To investigate the incidence and risk factors of acute kidney injury(AKI) requiring continuous renal replacement treatment(CRRT) in patients with acute type A aortic dissection after Sun' s operation. Methods A retrospective analysis of consecutive patients with acute type A aortic dissection underwent Sun' s operation in Beijing Anzhen Hospital, Capital Medical University from January 2009 to December 2015. These patients were divided into two groups according to whether had severe postoperative AKI requiring CRRT treatment: the dialysis group(AG, 65 cases) and the control group(CG, 618 cases), we compared the clinical outcomes of patients in two groups and analyzed the related risk factors. Results 50 patients(7.3%) died in hospital. Compared with patients in CG group, patients in AG group had higher age, more patients with preoperative coronary heart disease, pericardial tamponade, and higher rates of intraoperative coronary artery bypass surgery or valve surgery, the results were statistically different between the two groups(P<0.05). The patients in AG group had a higher mortality rate in hospital(26.2% vs. 5.3%), and the difference was statistically significant(P<0.001). The results of multiple regression analysis suggested that the age >50 years, preoperative history of pericardial tamponade, intraoperative need for combined coronary artery bypass grafting or valve surgery, and cerebral perfusion time>40 min were independent risk factors for CRRT treatment of postoperative severe AKI(P<0.05). Conclusion The incidence of severe AKI requiring CRRT treatment in patients with acute type A aortic dissection after Sun' s operation was 9.5%, and the discharge survival rate in AG group was lower than that in CG group. An important way to reduce the incidence of severe AKI requiring CRRT after sun' s surgery is to shorten the intraoperative cerebral perfusion time as much as possible.