心脏手术术后发生急性肾损伤的相关因素

Influencing factors of postoperative acute kidney injury in patients undergoing cardiac surgery

目的分析使用左西孟旦或多巴酚丁胺的心脏手术术后患者发生急性肾损伤(AKI)的影响因素,并探究正性肌力药物对AKI的影响。方法回顾性研究。收集北京安贞医院2018年1至6月行心脏手术并在围手术期泵入左西孟旦或多巴酚丁胺患者的临床资料,并根据是否发生AKI将患者分为AKI组和非AKI组。采用单因素logistic回归分析AKI发生的相关因素,将单因素分析有统计学意义的因素(P<0.05)纳入多因素logistic回归分析模型。结果纳入研究的患者共417例,年龄(58.2±10.4)岁,男271例(65.0%),AKI发生率为25.2%(105/417)。单因素logistic回归分析结果显示,男性、慢性肾脏病、术前血肌酐水平高、主动脉阻断时间≥120 min,体外循环时间≥120 min均为心脏术后AKI的相关危险因素(均P<0.05);围手术期应用血管扩张剂、左西孟旦则为保护因素(均P<0.05)。多因素logistic回归分析结果显示,慢性肾脏病(OR=17.291,95%CI:4.335~68.960,P<0.001)、术前高血肌酐水平(OR=1.097,95%CI:1.074~1.121,P<0.001)为心脏术后AKI的独立危险因素,围手术期应用左西孟旦(OR=0.533,95%CI:0.288~0.984,P=0.044)为独立保护因素。结论心脏术后发生AKI的危险因素包括慢性肾脏病和术前高血肌酐水平,而围手术期左西孟旦的使用可能具有潜在的保护作用。

Objective To analyze the influencing factors of acute kidney injury(AKI)in patients after cardiac surgery using levosimendan or dobutamine,and explore the effect of positive inotropic drugs on AKI.Methods The clinical data of 417 patients undergoing cardiac surgery from January to June 2018 in Beijing Anzhen Hospital and treated with levosimendan or dobutamine during perioperative period were retrospectively reviewed and collected.Patients were divided into AKI group and non-AKI group according to whether AKI occurred.Univariate logistic regression analysis was used to analyze the factors related to the occurrence of AKI.The statistically significant factors(P<0.05)were further included in the multivariate logistic regression analysis.Results Totally,417 patients were enrolled in the study,with a mean age of(58.2±10.4)years old and a male rate of 65.0%(n=271),and the AKI incidence rate was 25.2%(105/417).Univariate logistic regression analysis showed that male,chronic kidney disease,high serum creatinine level in preoperative period,aortic obstruction time≥120 minutes and extracorporeal circulation time≥120 minutes were risk factors for AKI(all P<0.05).Vasodilator and levosimendan treatment during perioperative period were protective factors(P<0.05).Multivariate logistic regression analysis showed that chronic kidney disease(OR=17.291,95%CI:4.335-68.960,P<0.001)and high serum creatinine level(OR=1.097,95%CI:1.074-1.121,P<0.001)in preoperative period were independent risk factors for AKI.Perioperative application of levosimendan(OR=0.533,95%CI:0.288-0.984,P=0.044)was an independent protective factor.Conclusions Risk factors for AKI after cardiac surgery include chronic kidney disease and high serum creatinine level in preoperative period.The use of levosimendan during preoperative period has the potential effect to protect against AKI.