机器人心脏外科术后急性肾功能损伤的危险因素分析

Risk factors of acute kidney injury after robotic cardiac surgery

目的:分析机器人心脏外科手术的安全性及有效性,探讨术后急性肾功能损伤(CSA-AKI)的危险因素。方法:回顾性分析陆军军医大学大坪医院2016年7月—2022年6月147例机器人体外循环(CPB)下心脏外科手术患者的资料,统计其人口学资料及相关临床资料。按患者术后是否发生CSA-AKI,将其分为CSA-AKI组(37例)与非CSA-AKI组(109例),1例患者因术后早期死亡未纳入分组。对两组围术期危险因素进行单因素分析,再将筛选出的有意义的变量纳入多因素logistic回归分析。结果:147例机器人心脏外科术后发生CSA-AKI 37例,发生率为25.34%,1期CSA-AKI 28例(19.18%),2期CSA-AKI 6例(4.11%),3期CSA-AKI 3例(2.05%),肾功能衰竭透析1例(0.68%),院内死亡1例(0.68%)。CSA-AKI组与非CSA-AKI组年龄、性别、肥胖分级、高血压、吸烟、饮酒、NYHA分级、左房前后径(LAD)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、丙氨酸氨基转移酶(ALT)、手术时间、主动脉阻断时间、CPB时间及手术类型均差异有统计学意义(均P<0.05)。多因素logistic回归分析提示,术前TG(OR=1.756,95%CI:1.058~2.914,P=0.029)与手术时间≥300 min(OR=3.649,95%CI:1.061~12.553,P=0.04)是机器人心脏外科术后CSA-AKI的独立危险因素。CSA-AKI组术后气管带管时间、监护室停留时间、术后住院时间明显延长,术后肺部感染、肝功能损伤及低蛋白血症发生率明显增加,术后大剂量输血事件明显增加(均P<0.05)。结论:术前TG、手术时间≥300 min是机器人心脏外科术后CSA-AKI的独立危险因素;CSA-AKI患者术后气管带管时间、监护室停留时间、术后住院时间明显延长,术后肺部感染、肝功能损伤、低蛋白血症发生率明显增加,术后大剂量输血事件显著增加。

Objective: To analyze the safety and efficacy of robotic cardiac surgery, and to explore the risk factors of postoperative acute kidney injury(CSA-AKI). Methods: The data of 147 patients who underwent cardiac surgery under robotic cardiopulmonary bypass(CPB) from July 2016 to June 2022 in Daping Hospital of Army Medical University were retrospectively analyzed, and their demographic data and related clinical data were statistically analyzed. The patients were divided into the CSA-AKI group(n=37) and the non-CSA-AKI group(n=109) according to whether CSA-AKI occurred after operation, and 1 patient died in the early postoperative period and was not included in the group. Univariate analysis was performed for perioperative risk factors in both groups, followed by multivariate logistic regression analysis for variables selected to be more significant. Results: Thirty-seven of 147 patients(25.34%) developed CSA-AKI after robotic cardiac surgery, 28(19.18%) had stage 1 CSA-AKI, 6(4.11%) had stage 2 CSA-AKI, 3(2.05%) had stage 3 CSA-AKI, 1(0.68%) had renal failure dialysis, and 1(0.68%) died in the hospital. There were significant differences in age, gender, obesity class, hypertension, smoking, alcohol consumption, NYHA class, left atrial anteroposterior diameter(LAD), triglyceride(TG), high-density lipoprotein cholesterol(HDL-C), alanine aminotransferase(ALT), operation time, aortic cross-clamp time, CPB time, and operation type in CSA-AKI group and non-CSA-AKI group(all P<0.05). Multivariate logistic regression analysis suggested that preoperative TG(OR=1.756, 95%CI: 1.058-2.914, P=0.029) and operation time ≥ 300 min(OR=3.649, 95%CI: 1.061-12.553, P=0.04) were independent risk factors for CSA-AKI after robotic cardiac surgery. In the CSA-AKI group, the postoperative tracheal intubation time, intensive care unit stay, and postoperative hospital stay were significantly prolonged, the incidence of postoperative pulmonary infection, liver function injury, and hypoproteinemia was significantly increased, and postoperative high-dose transfusion events were significantly increased(all P<0.05). Conclusion: Preoperative TG and operation time ≥ 300 min were independent risk factors of CSA-AKI after robotic cardiac surgery. In patients with postoperative CSA-AKI, postoperative tracheal intubation time, intensive care unit stay, and postoperative hospital stay were significantly prolonged, the incidence of postoperative pulmonary infection, liver function injury, and hypoproteinemia are significantly increased, and postoperative high-dose blood transfusion events are significantly increased.