Stanford A型主动脉夹层患者手术后发生急性肾损伤且行连续性肾脏替代治疗的危险因素分析

Incidence and Risk Factors of Continuous Renal Replacement Therapy for Acute Renal Injury After Surgical Treatment of Stanford A Aortic Dissection

目的:探讨分析Stanford A型主动脉夹层患者手术后发生急性肾损伤且需行连续性肾脏替代治疗(CRRT)的危险因素。方法:回顾性收集2010年1月至2017年12月在本中心接受手术治疗的1378例Stanford A型主动脉夹层患者的临床资料,手术方式根据主动脉根部病变特点和夹层累及范围进行选择。根据术后是否发生急性肾损伤且行CRRT将患者分为非CRRT组(n=1263)和CRRT组(n=115),并纳入两组患者围手术期的各项指标,分析术后发生急性肾损伤且需行CRRT的危险因素。结果:1378例患者术后CRRT使用率为8.3%(115/1378),术后30 d内死亡率为6.6%(91/1378)。其中CRRT组死亡47例,非CRRT组死亡44例;CRRT组死亡率是非CRRT组的11.7倍(40.8%vs.3.5%,P<0.001)。多因素Logistic回归分析显示,年龄(OR=1.028,95%CI:1.011~1.045),术前肝功能不全(OR=2.061,95%CI:1.011~4.199),红细胞输注量(OR=1.08,95%CI:1.043~1.119)是术后发生急性肾损伤行CRRT的独立危险因素(P均<0.05)。结论:患者年龄、术前肝功能不全、红细胞输注量是Stanford A型主动脉夹层患者手术后发生急性肾损伤且行CRRT的独立危险因素。

Objectives:To observe the incidence and analyze the risk factors of continuous renal replacement therapy(CRRT)for acute renal injury after surgical treatment of Stanford A aortic dissection.Methods:The clinical data of 1378 Stanford type A aortic dissection patients,who underwent surgical treatment in our center from January 2010 to December 2017,were retrospectively collected and analyzed.The operation procedure was selected and performed according to the extent of dissection involved and the characteristics of aortic root lesions.Patients were divided into non-CRRT group(n=1263)and CRRT group(n=115)based on the absence or presence of CRRT after surgical operation.Perioperative and operative factors were compared between the two groups.Results:The incidence of CRRT was 8.3%(115/1378).There were 91(6.6%)deaths within 30 days post operation(47[40.8%]deaths in the CRRT group and 44[3.5%]deaths in the non-CRRT group),the mortality rate in the CRRT group was 11.7 times higher than that in the non-CRRT group(P<0.001).Logistic multivariate regression analysis showed that age(OR=1.028,95%CI:1.011-1.045),preoperative liver damage(OR=2.061,95%CI:1.011-4.199),volume of RBC transfusion(OR=1.08,95%CI:1.043-1.119)were the independent risk factors for severe acute renal injury requiring CRRT treatment.Conclusions:CRRT is associated with higher early mortality in patients undergoing surgical treatment of Stanford A aortic dissection.Senior age,preoperative liver damage and volume of RBC transfusion are independent risk factors for postoperative CRRT.These factors should be monitored and managed carefully during the perioperative and post-operative period for the purpose of renal function protection and prevention of acute renal injury in this patient cohort.