合并巨大左心室的心脏瓣膜病患者术后发生急性肾损伤的危险因素分析

Risk factors of acute kidney injury after cardiac valvular surgery in patients with valvular disease complicated with giant left ventricle

目的探讨合并巨大左心室的心脏瓣膜病患者心脏瓣膜术后发生急性肾损伤(AKI)的危险因素。方法回顾性分析2018-01-2020-12在阜外华中心血管病医院行心脏瓣膜手术且合并巨大左心室的心脏瓣膜病患者的临床资料,根据术后是否发生AKI,分为AKI组和非AKI组。比较2组患者的基线、术中和术后资料。将单因素分析中P<0.2的变量放入多因素Logistic回归方程中,分析AKI与各因素的相关性。随后将连续型变量放入构建的回归模型中进行趋势性检验,进一步分析连续型变量对AKI的影响。结果研究共纳入132例合并巨大左心室的心脏瓣膜病患者,年龄(52.9±12.5)岁;28例于术后发生AKI,非AKI组104例。单因素分析结果显示,合并糖尿病、合并脑血管疾病、围术期输血、主动脉阻断时间、体外循环时间等项目的差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,基础血肌酐升高(OR=3.311,95%CI 1.086~10.096,P=0.035)、主动脉阻断时间(OR=1.022,95%CI 1.008~1.037,P=0.003)、围术期输血(OR=2.850,95%CI 1.036~7.842,P=0.043)、术前合并脑血管疾病(OR=3.878,95%CI 1.324~11.361,P=0.013)是术后AKI的独立危险因素。与主动脉阻断时间≤70 min比较,>70~90 min(OR=1.730,95%CI 0.527~5.674)、>90 min(OR=3.359,95%CI 1.174~9.615)患者术后AKI发生风险逐渐升高;随着术中主动脉阻断时间增加,AKI发生风险呈上升趋势(趋势检验P=0.019)。结论基础血肌酐升高、主动脉阻断时间增加、围术期输血、术前合并脑血管疾病,是合并巨大左心室的心脏瓣膜病患者术后发生AKI的危险因素。

Objective To investigate the risk factors of acute kidney injury(AKI)after cardiac valvular surgery in patients with valvular disease complicated with giant left ventricle.Methods The clinical data from 2018-01 to 2020-12 patients with large left ventricle were analyzed.AKI group and AKI group or non-AKI group.Baseline,intraoperative and postoperative data were compared between 2 group.Variables with P<0.2 in the univariate analysis were included into the multivariate Logistic regression equation to analyze the association of AKI with each factor.The continuous variables were subsequently put into the constructed regression model for trend testing to further analyze the effect of the continuous variables on AKI.Results A total of 132 patients with cardiac valve disease with giant left ventricle,age(52.9±12.5),28 cases had postoperative AKI,104 cases in the non-AKI group.The results of univariate analysis showed statistically significant differences between combined diabetes mellitus,combined cerebrovascular disease,perioperative blood transfusion,aortic blockade time,and cardiopulmonary bypass time(P<0.05).Multivariate Logistic regression analysis showed that the elevated basic serum creatinine(OR=3.311,95%CI 1.086~10.096,P=0.035),aortic cross-clamp time(OR=1.022,95%CI 1.008~1.037,P=0.003),blood transfusion(OR=2.850,95%CI 1.036~7.842,P=0.043)and cerebrovascular disease(OR=3.878,95%CI 1.324~11.361,P=0.013)were the independent risk factors of AKI after cardiac valvular surgery in patients with valvular disease complicated with giant left ventricle.Risk of AKI was significantly higher in patients with aortic cross-clamp time between 70 and 90 minutes(OR=1.730,95%CI 0.527~5.674)and 90 minutes and above(OR=3.359,95%CI 1.174~9.615)than in patients with aortic cross-clamp time≤70 minutes.The trend test results showed that the risk of AKI increased significantly in proportion with the increase of aortic cross-clamp time(P for trend=0.019).Conclusion The risk factors of AKI after cardiac valvular surgery are the elevated basic serum creatinine,increased aortic cross-clamp time,blood transfusion and preoperative cerebrovascular disease in patients with valvular disease complicated with giant left ventricle.