摘要
目的探讨在深低温停循环（DHCA）下行主动脉弓置换术后发生急性肾损伤（AKI）的危险因素。方法回顾性分析2004年1月至2008年12月期间首都医科大学附属北京安贞医院139例行主动脉弓置换术患者的临床资料,依术后是否发生AKI将139例患者分为两组,肾功能正常组（n=91）：男69例,女22例;年龄41.30±13.37岁;AKI组（n=48）：男39例,女9例;年龄57.67±9.56岁。观察两组患者的临床资料,包括术前左心室射血分数（LVEF）、左心室内径、升主动脉直径、肾功能、体外循环时间、主动脉阻断时间、停循环时间等指标的改变,采用单因素和logistic多因素回归分析导致患者术后发生AKI和死亡的危险因素。结果 139例患者中术后发生AKI48例（34.53%）,其中行连续性肾脏替代治疗（CRRT）17例（12.23%）,发生呼吸衰竭27例（19.42%）,脑部并发症29例（20.86%）,包括暂时性脑损害26例,永久性脑损害3例。住院死亡14例（10.07%）,其中死于心力衰竭4例,多器官功能衰竭9例,多发性脑梗死1例。肾功能正常组死亡3例（3.30%）,AKI组死亡11例（22.92%）,两组病死率比较差异有统计学意义（P=0.011）。随访118例,随访时间5~56个月,平均随访42个月,失访7例。随访期间死亡7例,其中死于心力衰竭3例,脑卒中2例,死亡原因不明2例。logistic回归分析结果显示：术前血肌酐〉132.60μmol/L（OR=1.042,P=0.021）和术后发生呼吸衰竭（OR=2.057,P=0.002）是导致主动脉弓置换术后发生AKI的独立危险因子。结论主动脉弓置换术后AKI的发生率较高,是手术死亡的危险因素,应加强围术期肾功能保护。
Objective To determine the risk factors for acute kidney injury（AKI） after thoracic aortic arch replacement surgery under deep hypothermic circulatory arrest（DHCA）.Methods We retrospectively analyzed the clinical data of 139 patients who underwent thoracic aortic arch replacement surgery under DHCA between January 2004 and December 2008 in Beijing Anzhen Hospital Affiliated to Capital University of Medical Sciences.The patients were divided into two groups according to whether AKI occurred after thoracic aortic arch replacement surgery.In the AKI group（n=48）,there were 39 males and 9 females with an age of 57.67±9.56 years.In the normal renal function group（n=91）,there were 69 males and 22 females with an age of 41.30±13.37 years.We observed the clinical data of the patients in both groups,including left ventricular ejecting fraction（LVEF） before operation,diameter of the left ventricle,diameter of the ascending aorta,renal function,cardiopulmonary bypass time,aortic cross-clamp time,and DHCA time.The risk factors for AKI and death after operation were evaluated by univariate analysis and stepwise logistic regression analysis.Results Among all the patients,AKI occurred in 48（34.53%）,17（12.23%） of whom underwent continuous renal replacement therapy（CRRT）.Respiratory failure occurred in 27 patients（19.42%）.Twenty-nine patients（20.86%） had cerebral complications,including temporary cerebral dysfunction in 26 patients and permanent cerebral dysfunction in 3 patients.In all the patients,14（10.07%） died,including 4 patients of heart failure,9 patients of multiple organ failure,and 1 patient of cerebral infarction.There were 3（3.30%）deaths in the normal renal function group and 11（22.92%） deaths in the AKI group with a significant difference of mortality rate between the two groups（P=0.011）.A total of 118 patients were followed up and 7 were lost.The follow-up time was from 5 to 56 months with an average time of 42 months.During the follow-up period,7 patients died,including 3 patients of heart failure,2 patients of cerebral apoplexy,and 2 patients of unknown reasons.The logistic regression analysis revealed that creatinine level was greater than 132.60 μmol/L before operation（OR=1.042,P=0.021） and respiratory failure（OR=2.057,P=0.002） were independent determinants for AKI after the operation.Conclusion AKI is the most common complication of thoracic aortic arch replacement surgery under DHCA,and is the risk factor of mortality after the surgery.It is important to enhance peri-operative protection of the renal function.
出处
《中国胸心血管外科临床杂志》
CAS
2011年第2期109-113,共5页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
关键词
主动脉弓置换术
深低温停循环
急性肾损伤
Aortic arch replacement surgery
Deep hypothermic circulatory arrest
Acute kidney injury
