心脏外科手术后急性肾损伤患者的临床特征

Characteristic of cardiac surgery patients with acute kidney injury

目的:观察心脏外科手术后急性肾损伤(AKI)的发生率、临床特点及危险因素,为临床更好地认识、早期干预提供依据。方法:回顾性分析2017年7月至2018年6月西安交通大学第一附属医院行心脏外科手术的患者,筛选出AKI患者及非AKI患者,记录病例资料、分析其危险因素。结果:行心脏外科手术的患者575例,术后发生AKI的患者177例(30.78%),AKI组病死率显著高于非AKI组(10.17%vs 0.5%,P<0.001)。心脏术后AKI主要发生在术后24h内,且以AKI 1期为主。AKI 1期、2期及3期发生率分别为19.13%(110/575)、5.22%(30/575)、6.43%(37/575),各期死亡率分别为2.72%(3/110)、10.00%(3/30)、32.43%(12/37),三组间病死率差异有统计学意义。多因素Logistic回归分析结果显示,体外循环手术(OR=1.436,95%CI 1.168~1.765)、高龄(每增加10岁)(OR=1.623,95%CI 1.168~2.009)、既往心脏手术史(OR=7.807,95%CI 1.338~45.563)、术前胱抑素C高水平(OR=3.576,95%CI 1.39~9.197)、围术期感染(OR=1.436,95%CI 1.168~1.765)、心肺旁路时间(每增加30 min)(OR=1.457,95%CI 1.077~1.971)是心脏术后AKI发生的独立危险因素。结论:心脏外科手术后AKI发生率为30.78%,AKI组患者死亡率较非AKI组显著增加,应警惕其危险因素,做到早诊断早干预。

Objective:To observe the incidence,clinical characteristics and risk factors of acute kidney injury(AKI) after cardiac surgery in our hospital,and provide evidence for better understanding and early intervention. Methodology:Retrospective analysis of patients with cardiac surgery from July 2017 to June 2018 in the First Affiliated Hospital of Xi′an Jiaotong University,screening patients with AKI and non-AKI recording their clinical data and analyzing risk factors. Results:Five hundred seventy-five patients were involved,AKI developed in 177(30.78%) patients,whereas 4.17% of them received renal replacement therapy.Patients with AKI had significant higher mortality than patients without AKI(10.17% vs 0.5%,P<0.001). The incidence of AKI stage 1,2,and 3 was 19.13%(110/575),5.22%(30/575),and 6.43%(37/575) respectively,and the mortality was 2.72%(3/110),10%(3/30) and 32.43%(12/37).There was a statistically significant difference in mortality between three groups(P<0.001). Multivariate Logistic regression analysis showed that cardiopulmonary bypass(OR=1.436,95% CI 1.168~1.765),advanced age(OR=7.807,95% CI 1.338~45.563),previous cardiac surgery(OR=7.807,95% CI 1.338~45.536),high level of preoperative blood Cystatin C(OR=3.576,95% CI 1.39~9.197),perioperative infection(OR=1.436,95% CI 1.168~1.765) and intraoperative cardiopulmonary bypass time(OR=1.457,95% CI 1.077~1.971)were the independent risk factors of AKI after cardiac surgery. The occurrence of AKI after cardiac surgery was mainly within 24 hours after surgery,accounting for 80.23% of AKI patients. Conclusion:AKI can occur early after cardiac surgery in 30.78% of patients.AKI has a significantly increased mortality compared with non-AKI patients.It should be alert to its risk factors and early intervention.