Stanford A型主动脉夹层术后早期发生急性肾损伤的影响因素

Influencing factors of early acute kidney injury after surgery for Stanford type A aortic dissection

目的探讨急性Stanford A型主动脉夹层(acute Stanford type A aortic dissection,AAAD)患者术后早期发生急性肾损伤(acute kidney injury,AKI)的影响因素,为减少AAAD患者术后早期发生AKI提供参考。方法行手术治疗的AAAD患者175例,术后48 h发生AKI者96例为AKI组,未发生AKI者79例为非AKI组。比较2组身高,脉压,手术时间≥8 h、高血压及脏器灌注不良发生率等临床资料;比较2组左室射血分数及血清肌酐、尿酸、谷草转氨酶水平等;多因素logistic回归分析AAAD患者术后早期发生AKI的影响因素。结果AKI组身高[(170.3±7.6)cm]低于非AKI组[(173.1±7.7)cm](P<0.05),脉压[(62.7±17.5)mm Hg]、血清谷草转氨酶水平[24.0(17.0,38.8)u/L]及高血压、手术时间≥8 h、脏器灌注不良比率(86.5%、8.3%、36.5%)高于非AKI组[(54.4±17.9)mm Hg、20.0(15.0,28.0)u/L、70.9%、1.3%、13.9%](P<0.05);2组年龄、性别比例、体质量等一般资料,左室射血分数及血清肌酐、尿酸水平比较差异均无统计学意义(P>0.05)。多因素logistic回归分析结果显示,身高(OR=0.955,95%CI:0.914~0.999,P=0.045),脏器灌注不良(OR=0.245,95%CI:0.109~0.555,P=0.001)、脉压(OR=1.027,95%CI:1.008~1.047,P=0.006)、手术时间(OR=8.787,95%CI:1.028~75.093,P=0.047)是AAAD患者术后早期发生AKI的影响因素。结论身高、脏器灌注不良、脉压、手术时间与AAAD患者术后早期发生AKI有关。

Objective To study the influencing factors of acute kidney injury(AKI)after surgery for acute Stanford type A aortic dissection(AAAD)and to provide reference for preventing early AKI after surgery in patients with AAAD.Methods Totally 175 patients undergoing surgery for AAAD were divided into 96 patients with AKI 48 h after surgery(AKI group)and 79 patients with no postoperative AKI(non-AKI group).The height,pulse pressure and the percentages of operation time≥8 h,hypertension and poor organ perfusion were compared between two groups.The left ventricular ejection fraction,and the laboratory indexes including serum creatinine,urine acid and giutanlic oxaloacetic transaminase were compared between two groups.Multivariate regression logistic analysis was used to analyze the influencing factors of early AKI after surgery in patients with AAAD.Results The height was shorter in AKI group((170.3±7.6)cm)than that in non-AKI group((173.1±7.7)cm)(P<0.05),the pulse pressure,serum glutamic oxaloacetic transaminase level,and the percentages of hypertension,operation time≥8 h and poor organ perfusion were higher in AKI group((62.7±17.5)mm Hg,24.0(17.0,38.8)u/L,86.5%,8.3%,36.5%)than those in non-AKI group((54.4±17.9)mm Hg,20.0(15.0,28.0)u/L,70.9%,1.3%,13.9%)(P<0.05),and there were no significant differences in the age,sex ratio,body mass,left ventricular ejection fraction,serum creatinine and urine acid between two groups(P>0.05).Multivariate regression logistic analysis results showed that the height(OR=0.955,95%CI:0.914-0.999,P=0.045),poor organ perfusion(OR=0.245,95%CI:0.109-0.555,P=0.001),pulse pressure(OR=1.027,95%CI:1.008-1.047,P=0.006),and operation time(OR=8.787,95%CI:1.028-75.093,P=0.047)were the influencing factors of early AKI after surgery for AAAD.Conclusion The height,poor organ perfusion,pulse pressure,and operation time are involved in early AKI after surgery in patients with AAAD.