心脏瓣膜病伴巨大左心室患者心脏瓣膜术后发生急性肾损伤的危险因素及干预对策

Risk Factors and Intervention Strategies of Acute Kidney Injury After Heart Valve Surgery in Patients with Valvular Heart Disease and Giant Left Ventricle

目的探讨心脏瓣膜病(VHD)伴巨大左心室患者心脏瓣膜术后发生急性肾损伤(AKI)的危险因素及干预对策。方法选取2020年6月至2023年1月在周口市中心医院收治的137例心脏瓣膜术治疗的VHD伴巨大左心室患者,统计患者术后AKI发生情况,并进行单因素分析与Logistic多因素回归分析。结果137例VHD伴巨大左心室患者心脏瓣膜术后发生AKI共32例,发生率为23.36%;AKI组男性、基础血肌酐升高、有高血压、有脑血管疾病、围术期输血的患者占比与非AKI组相比更高,AKI组体外循环时间、主动脉阻断时间比非AK组更长,差异有统计学意义(P<0.05);Logistic多因素分析结果显示,男性(OR=1.862)、基础血肌酐升高(OR=2.067)、合并高血压(OR=1.795)、合并脑血管疾病(OR=1.956)、体外循环时间≥120 min(OR=2.165)、主动脉阻断时间≥90 min(OR=1.882)、围术期输血(OR=2.034)是影响VHD伴巨大左心室患者心脏瓣膜术后发生AKI的独立危险因素,差异有统计学意义(P<0.05)。结论男性、基础血肌酐升高、合并高血压及脑血管疾病、体外循环时间及主动脉阻断时间过长、围术期输血均是VHD伴巨大左心室患者心脏瓣膜术后发生AKI的危险因素,需采取有效的干预对策。

Objective To explore the risk factors and intervention strategies for acute kidney injury(AKI)after cardiac valve surgery in patients withheart valve disease(VHD)and giant left ventricle.Methods A retrospective analysis was conducted on 137 patients with VHD and giant left ventricle who were underwent cardiac valve surgery in our hospital from June 2020 to January 2023.The incidence of postoperative AKI was analyzed and univariate analysis and Logistic regression analysis were performed.Results A total of 32 cases of AKI occurred after cardiac valve surgery in 137 patients with VHD and giant left ventricle,with an incidence rate of 23.36%.In comparision of the non AKI group,the proportion of male patients,patients with elevated creatinine in basic blood,hypertension,cerebrovascular disease and perioperative blood transfusion of the AKI group was higher,the extracorporeal circulation time and aortic occlusion time in the AKI group were longer than those in the non AKI group,and the difference was statistically significant(P<0.05).Logistic multivariate analysis showed that male(OR=1.862),increased creatinine in basal blood(OR=2.067),hypertension(OR=1.795),Cerebrovascular disease(OR=1.956),extracorporeal circulation time≥120 min(OR=2.165),aortic occlusion time≥90 min(OR=1.882),and perioperative blood transfusion(OR=2.034)were independent risk factors for AKI after heart valve surgery in patients with VHD and giant left ventricle,and the difference was statistically significant(P<0.05)).Conclusion Male,elevated creatinine in basal blood,hypertension and Cerebrovascular disease,too long cardiopulmonary bypass time and aortic occlusion time,and perioperative blood transfusion are all risk factors for AKI in patients with VHD and giant left ventricle after heart valve surgery,and effective intervention measures should be taken.