急性Stanford A型主动脉夹层患者行急诊手术后应用连续性肾脏替代治疗的危险因素分析

The risk factors of postoperative continuous renal replacement therapy application in Stanford type A acute aortic dissection

目的探讨急性Stanford A型主动脉夹层患者行急诊手术后应用连续性肾脏替代治疗(CRRT)的危险因素。方法纳入首都医科大学附属北京安贞医院2015年11月至2018年2月收治的急性Stanford A型主动脉夹层行急诊手术患者527例。根据术后是否行CRRT分为CRRT组(78例)和非CRRT组(449例)。采用二元logistic回归分析患者术后行CRRT的危险因素。结果所有患者中CRRT的使用率14.8%(78/527),术后30天病死率8.5%(45/527)。术前血肌酐值(OR=1.012,95%CI:1.005~1.019,P<0.001)、术中悬浮少白红细胞输注量(OR=1.141,95%CI:1.071~1.216,P<0.001)、术中血小板输注量(OR=1.307,95%CI:1.084~1.576,P=0.005)、术后胸腔引流总量(OR=1.000,95%CI:1.000~1.000,P=0.036)及术后气管插管时间(OR=1.004,95%CI:1.001~1.008,P=0.013)是Stanford A型急性主动脉夹层患者急诊手术后需应用CRRT的独立危险因素。结论急性Stanford A型主动脉夹层患者急诊手术后出现急性肾损伤需行CRRT的危险因素有术前血肌酐水平、术中悬浮少白红细胞及血小板输注量、术后气管插管时间及术后胸腔引流总量。临床工作中需要关注上述危险因素,做好应对,以改善患者的预后。

Objective To investigate the risk factors of postoperative continuous renal replacement therapy application in Stanford type A acute aortic dissection.Methods This retrospective study included 527 patients with Stanford type A acute aortic dissection from November 2015 to February 2018 in Beijing Anzhen Hospital.They were divided into 2 groups according to whether or not needed postoperative continuous renal replacement therapy,group CRRT(78 cases)and group None CRRT(449 cases).Binary logistic regression analysis was used to analyze the risk factors of continuous renal replacement therapy.Results Of all the patients,the percentage of using continuous renal replacement therapy was 14.8%(78/527),and the mortality of 30 days after surgery was 8.5%(45/527).The independent risk factors associated with CRRT were preoperative serum creatinine(sCr)(OR=1.012,95%CI:1.005-1.019,P<0.001),transfusion of red blood cell in surgery(OR=1.141,95%CI:1.071-1.216,P<0.001),transfusion of platelet in surgery(OR=1.307,95%CI:1.084-1.576,P=0.005),the total amount of drainage(OR=1.000,95%CI:1.000-1.000,P=0.036),and the time of extubation after surgery(OR=1.004,95%CI:1.001-1.008,P=0.013).Conclusion The risk factors of CRRT after emergency surgery of Stanford type A acute aortic dissection are preoperative serum creatinine,transfusion of red blood cell in surgery,transfusion of platelet in surgery,the total amount of drainage and the time of tracheal extubation after surgery.We need to focus on those risk factors in our daily job and manage them timely and properly,in order to improve patients’prognosis.