急性Stanford A型主动脉夹层患者术后急性肾损伤及其对预后的影响

Incidence of postoperative acute kidney injury and risk factors for prognosis in patients with acute Stanford type A aortic dissection

目的 分析急性Stanford A型主动脉夹层患者术后急性肾损伤(acute kidney injury,AKI)发生情况及其对预后的影响及近中期预后相关危险因素。方法 回顾性分析2014年5月—2019年5月于青岛市市立医院心脏中心行外科手术治疗的Stanford A型主动脉夹层患者的临床资料。所有出院患者均进行电话或门诊随访,根据术后是否发生AKI将患者分为AKI组和非AKI组。分析术后AKI对近中期预后的影响,并通过多因素Cox风险回归分析患者近中期死亡的危险因素。结果 共纳入192例患者,其中男139例、女53例,年龄(53.3±11.4)岁。43例患者发生AKI,发生率为22.4%。出院患者平均随访时间(23.4±2.4)个月,失访率5.1%。AKI组患者出院后2年生存率为88.2%,非AKI组为97.2%,Kaplan-Meier生存分析和log-rank检验结果显示两组差异有统计学意义(χ^(2)=5.355,log-rank P=0.021)。Cox风险回归分析显示:年龄[HR=1.070,95%CI(1.026,1.116),P=0.002]、术中体外循环时间[HR=1.026,95%CI(1.003,1.050),P=0.026]、术后AKI[HR=3.681,95%CI(1.579,8.582),P=0.003]、术中及术后24 h红细胞输注量[HR=1.548,95%CI(1.183,2.026),P=0.001]均是急性Stanford A型主动脉夹层患者近中期死亡的独立危险因素。结论 急性Stanford A型主动脉夹层患者术后AKI发生率较高,术后AKI患者2年内死亡率明显上升。同时,年龄、体外循环时间和术中及术后24 h内红细胞输注量也是近中期死亡的独立危险因素。

Objective To investigate the prognosis and impact of postoperative acute kidney injury(AKI)on patients with acute Stanford type A aortic dissection(ATAAD),and to analyze the predictors for short-and medium-term survival.Methods Clinical data of patients who underwent ATAAD surgery in Qingdao Municipal Hospital from May 2014 to May 2019 were retrospectively analyzed.All discharged patients underwent telephone or outpatient follow-up,and were divided into an AKI group and a non-AKI group based on whether AKI occurred after surgery.The impact of postoperative AKI on the short-and medium-term prognosis was analyzed,and multivariate Cox analysis was used to screen the risk factors for short-and medium-term mortality.Results A total of 192 patients were collected,including 139 males and 53 females,with an average age of 53.3±11.4 years.Postoperative AKI was identified in 43(22.4%)patients.The average follow-up time of discharged patients was 23.4±2.4 months,and the lost rate was 5.1%.The two-year survival rate after discharge of the AKI group was 88.2%,and that of the non-AKI group was 97.2%.Kaplan-Meier survival analysis and log-rank test showed that there was a statistical difference between the two groups(χ^(2)=5.355,log-rank P=0.021).Multivariate Cox analysis results showed that age(HR=1.070,95%CI 1.026 to 1.116,P=0.002),cardiopulmonary bypass time(HR=1.026,95%CI 1.003 to 1.050,P=0.026),postoperative AKI(HR=3.681,95%CI 1.579 to 8.582,P=0.003),transfusion volume of red blood cell intraoperatively and within 24 hours postoperatively(HR=1.548,95%CI 1.183 to 2.026,P=0.001)were independent risk factors for the short-and medium-term mortality of ATAAD patients.Conclusion The incidence of postoperative AKI is high in ATAAD patients,and the mortality of patients with AKI increases significantly within two years.Age,cardiopulmonary bypass time and transfusion volume of red blood cell intraoperatively and within 24 hours postoperatively are also independent risk factors for short-and medium-term prognosis.