A型主动脉夹层术后重度急性肾损伤的危险因素与透析策略分析

Analysis of risk factors and dialysis strategies for severe acute kidney injury after type A aortic dissection operation

目的探讨A型主动脉夹层术后重度急性肾损伤(AKI)的危险因素及其诊断价值,分析不同肾脏替代治疗的透析策略对重度AKI的疗效。方法回顾性收集该院2019年1月至2021年12月行A型主动脉夹层术后发生重度AKI的69例患者临床资料,分为重症组(滤过治疗,24例)和轻症组(未滤过治疗,45例)。比较两组临床资料,通过单因素及多因素logistic回归分析、受试者工作特征(ROC)曲线分析A型主动脉夹层术后发生重度AKI的危险因素及其诊断价值;比较术后治疗指标变化,分析不同透析策略疗效。结果术后重度AKI发生率为34.78%。单因素及多因素logistic回归分析显示,术前血肌酐升高(OR=0.98,95%CI:0.97~0.99,P=0.02)、体外循环总时间延长(OR=0.99,95%CI:0.97~0.99,P=0.02)、术后24 h输血量增加(OR=0.99,95%CI:0.98~0.99,P<0.01)是A型主动脉夹层术后发生重度AKI的独立危险因素。ROC曲线分析显示,体外循环总时间、术前血肌酐、术后24 h输血量联合对A型主动脉夹层术后发生重度AKI有较高的诊断价值,灵敏度、特异度及曲线下面积分别为91.10%、75.00%、0.90。早期行滤过及使用持续肾脏替代治疗(CRRT)对重度AKI有更好的疗效。结论A型主动脉夹层术后发生重度AKI的独立危险因素包括术前血肌酐升高、术中体外循环总时间延长和术后24 h输血量增加,且三者联合对重度AKI有较高的诊断价值。早期发现并及时使用肾脏替代治疗能够改善重度AKI,CRRT较间歇性血液透析治疗(IHD)效果好。

Objective To investigate the risk factors and diagnostic value of severe acute kidney injury(AKI)after type A aortic dissection,and to analyze the efficacy of different dialysis strategies of renal replacement therapy on severe AKI.Methods The clinical data of 69 patients with severe AKI after type A aortic dissection operation in this hospital from January 2019 to December 2021 were retrospectively collected.The patients were divided into the severe group(dialysis treatment,24 cases)and the mild group(without conducting filtration treatment,45 cases).The clinical data were compared between the two groups,and the risk factors and diagnostic value for the severe AKI occurrence after type A aortic dissection surgery by univariate and multivariate regression and receiver operating characteristic(ROC)curve.The changes of postoperative treatment indicators were compared and the efficacy of different dialysis strategies were analyzed.Results The incidence rate of severe AKI after surgery was 34.78%.The univariate and multivariate logistic regression analyses results showed that preoperative serum creatinine increase(OR=0.98,95%CI:0.97-0.99,P=0.02),total extracorporeal circulation time prolongation(OR=0.99,95%CI:0.97-0.99,P=0.02)and postoperative 24 h blood transfusion volume increase(OR=0.99,95%CI:0.98-0.99,P<0.01)were the independent risk factors for postoperative severe AKI occurrence in the patients with type A aortic dissection.The ROC curve analysis suggested that the combination of total time of extracorporeal circulation,preoperative serum creatinine value and postoperative 24 h blood transfusion volume had good diagnostic value for postoperative severe AKI occurrence in the patients with type A aortic dissection.The sensitivity,specificity and area under the curve were 91.10%,75.00%and 0.90 respectively.Early performing filtration and continuous renal replacement therapy(CRRT)in the severe AKT had better effect.Conclusion The independent risk factors for postoperative severe AKI occurrence in type A aortic dissection include preoperative serum creatinine increase,intraoperative total extracorporeal circulation time prolongation and postoperative 24 h blood transfusion volume increase,and the three combination has good predictive value for severe AKI.Early detection and timely using renal replacement therapy could improve severe AKI,CRRT has a better effect for AKI than intermitlent hemodialysis(IHD).