DeBakey Ⅰ型主动脉夹层术后急性肾损伤的危险因素分析

Risk factors of acute kidney injury after surgery in patients with acute DeBakey Ⅰ aortic dissection

目的:分析急性DeBakeyⅠ型主动脉夹层术后急性肾损伤的危险因素并探讨肾脏保护措施。方法:回顾性分析2000年7月至2018年5月365例接受手术的急性DeBakeyⅠ型主动脉夹层患者,根据患者术后是否发生急性肾损伤分为急性肾损伤组和无急性肾损伤组,对两组术前、术中、术后相关临床特征进行比较,多因素条件logistic回归方法分析术后急性肾损伤的独立危险因素。结果:55例患者术后出现急性肾损伤,急性肾损伤组年龄明显大于无急性肾损伤组,术前合并马凡综合征、术前肾功能异常、术前心包积液、术前冠状动脉窦撕裂的比例均明显高于无急性肾损伤组,术中心肺转流时间、主动脉阻断时间、输注红细胞量、输注血小板量、术后24 h胸腔积液量均明显高于无急性肾损伤组,术前左室射血分数(LVEF)和术后血小板-淋巴细胞比值(PLR)则均明显低于无急性肾损伤组(P均<0.05)。多因素logistics回归分析显示术后发生肾损伤的独立危险因素为年龄>55.5岁(OR=4.292,95%CI:2.069~8.900,P<0.001)、术前肾功能异常(OR=3.601,95%CI:1.632~7.945,P=0.002)、心包积液(OR=2.230,95%CI:1.113~4.469,P=0.024)、术后24 h胸腔积液引流量>745 mL(OR=3.023,95%CI:1.484~6.158,P=0.002)及术后PLR降低(OR=1.004,95%CI:1.001~1.006,P=0.018)。结论:高龄、术前合并肾功能异常、心包积液、术后24 h胸腔积液量和术后PLR降低是急性DeBakeyⅠ型主动脉夹层患者术后发生急性肾损伤的独立危险因素。

Objective:To analyze the risk factors of acute kidney injury(AKI) after surgery in patients with acute DeBakey Ⅰ aortic dissection and to explore the renal protection measures. Methods:The records of 365 patients with acute DeBakey Ⅰ aortic dissection who underwent operation from July 2000 to May 2018 were reviewed retrospectively. According to the occurrence of AKI after operation, they were divided into AKI group and non-AKI group. The clinical characteristics before, during and after operation were compared between the two groups. The multivariable conditional logistic regression models were used to identify risk factors of AKI after operation. Results:Fifty-five patients suffered from AKI after operation. The patients in AKI group were older than non-AKI group. And the proportion of patients with Marfan syndrome, preoperative renal disorder, pericardial effusion, and tear of the coronary sinus were higher than non-AKI group. In AKI group, the cardiopulmonary bypass time, aortic occlusion time, intraoperative red blood cell transfusion, intraoperative platelet transfusion and postoperative 24-hour pleural fluid volume increased significantly; the left ventricular ejection fraction and postoperative platelet-lymphocyte ratio(PLR) were lower(all P<0.05). Multivariate logistic regression analysis showed that age above 55.5(OR=4.292, 95%CI 2.069-8.900, P<0.001), preoperative renal insufficiency(OR=3.601, 95%CI 1.632-7.945,P=0.002), pericardial effusion(OR=2.230, 95%CI 1.113-4.469, P=0.024), postoperative 24-hour pleural effusion fluid volume above 745 mL(OR=3.023, 95%CI 1.484-6.158,P=0.002), and postoperative PLR(OR=1.004, 95%CI 1.001-1.006,P=0.018) were risk factors for AKI after operation. Conclusions:Age, preoperative renal insufficiency, pericardial effusion, postoperative 24-hour pleural effusion and postoperative PLR are risk factors of AKI after operation in patients with acute DeBakey Ⅰ aortic dissection.