胸腹主动脉替换术后急性肾功能衰竭的危险因素分析

Risk Factors for Acute Renal Failure after Thoracoabdominal Aortic Aneurysm Surgery

目的探讨胸腹主动脉替换术后急性肾功能衰竭(ARF)的危险因素。方法选取2009年1月至2017年12月实施胸腹主动脉替换术的患者156例,ARF诊断采用改善全球肾脏病组织标准。依据是否发生术后ARF分为ARF组和无ARF组,采用单因素和多因素Logistic回归分析ARF的危险因素。结果156例患者中男性111例(71.2%)、女性45例(28.8%),年龄19~65岁,平均(40.4±10.9)岁。其中主动脉夹层者130例(83.3%)、动脉瘤者22例(14.1%)、假性动脉瘤者4例(2.6%),合并马凡综合征58例(37.2%),CrawfordⅠ型者6例(3.8%)、CrawfordⅡ型者128例(82.1%)、CrawfordⅢ型者20例(12.8%)、CrawfordⅣ型者2例(1.3%),主动脉破裂者3例(1.9%),急诊手术6例(3.8%)。术后30 d死亡9例(5.8%),永久脊髓损伤8例(5.1%)。术后36例(23.1%)发生ARF,18例(11.5%)需要透析。多因素Logistic回归分析显示吸烟(OR=2.637,95%CI=1.113~6.250,P=0.028)、术中悬浮红细胞用量≥6 U(OR=5.508,95%CI=2.144~11.930,P=0.000)和二开止血(OR=3.529,95%CI=1.298~9.590,P=0.013)为胸腹主动脉替换术后ARF的独立危险因素。结论吸烟、术中悬浮红细胞用量≥6 U和二开止血是胸腹主动脉替换术后ARF的独立危险因素。

Objective To investigate the risk factors associated with acute renal failure(ARF)after thoracoabdominal aortic aneurysm(TAAA)surgery.Methods A total of 156 patients underwent TAAA repair between January 2009 and December 2017.Renal failure was defined based on the Kidney Disease Improving Global Outcomes criteria.The patients were divided into ARF group and non-ARF group based on the presence/absence of postoperative ARF.The risk factors of ARF were analyzed by univariate analysis and multivariate logistic analysis.Results The subjects included 111 males and 45 females aged(40.4±10.9)years(range:19-65 years).The surgical reasons included aortic dissection(n=130,83.3%),aneurysm(n=22,14.1%),and pseudoaneurysm(n=4,2.6%).The degrees of repair included Crawford extent I in 6 patients(3.8%),extentⅡin 128 patients(82.1%),extentⅢin 20 patients(12.8%),and extentⅣin 2 patients(1.3%).There were 3 patients presented with aortic rupture and 6 patients received emergent operations.Nine patients(5.8%)died within 30 days after surgery,and 8 patients(5.1%)suffered from permanent paraplegia.Thirty-six patients(23.1%)had ARF after surgery,and 18 of them needed dialysis.Multivariate logistic analysis showed that smoking(OR=2.637,95%CI=1.113-6.250,P=0.028),packed red blood cell usage in operation(≥6 U)(OR=5.508,95%CI=2.144-11.930,P=0.000),reoperation for bleeding(OR=3.529,95%CI=1.298-9.590,P=0.013)were independent risk factors for ARF after TAAA repair.Conclusion Smoking,packed red blood cell usage in operation(≥6 U),reoperation for bleeding are the independent risk factors of ARF after TAAA surgery.