摘要
目的系统评价急性A型主动脉夹层术后急性肾损伤(AKI)的危险因素。方法计算机检索中国学术期刊全文数据库(CNKI)、万方数据库、中文科技期刊数据库、PubMed、Web of Science及Cochrane Library,检索时间从建库至2019年1月。收集有关急性A型主动脉夹层术后AKI的临床研究。采用卡斯尔-渥太华量表(NOS)评价纳入研究的质量。采用RevMan 5.3软件对收集的资料进行Meta分析。结果最终纳入16项研究,均为病例对照研究,共1728例患者,纳入研究NOS评分均为6分以上。Meta分析结果显示,性别[OR=1.58,95%CI(1.31,1.89),P<0.001]、体重指数[OR=1.05,95%CI(0.66,1.45),P<0.001]、高血压史[OR=1.58,95%CI(1.10,2.26),P=0.010]、吸烟史[OR=1.71,95%CI(1.12,2.61),P=0.010]、术前血肌酐值[OR=30.26,95%CI(20.17,40.35),P<0.00001]、术前白细胞总数[OR=1.73,95%CI(0.26,3.20),P=0.020]、体外循环时间[OR=25.60,95%CI(21.13,30.08),P<0.00001]、主动脉阻断时间[OR=13.24,95%CI(10.27,16.22),P<0.001]、深低温停循环时间[OR=2.58,95%CI(0.86,4.29),P=0.003]、全弓置换术[OR=2.31,95%CI(1.31,4.07),P=0.004]、术中输血量[OR=1.27,95%CI(0.29,2.24),P=0.010]、术后平均动脉压[OR=–2.41,95%CI(–4.59,–0.24),P=0.030]、术后二次出血再次手术[OR=4.19,95%CI(2.04,8.63),P<0.001]、术后急性呼吸功能不全[OR=6.61,95%CI(3.21,13.60),P<0.001]、术后机械通气时间[OR=48.51,95%CI(21.94,75.09),P<0.001]与急性A型主动脉夹层术后AKI相关。结论现有证据表明,性别、体重指数、高血压、吸烟、术前血肌酐水平、术前白细胞数、体外循环时间、主动脉阻断时间、深低温停循环时间、全弓置换术、术中输血量、术后平均动脉压、术后出血二次手术、术后急性呼吸功能不全和术后机械通气时间是急性A型主动脉夹层术后AKI的危险因素。医务人员可结合以上因素加强对急性A型主动脉夹层患者围术期的管理,从而降低术后AKI发生率,改善患者临床预后结局。
Objective To systematically evaluate the risk factors of acute kidney injury after surgery for acute type A aortic dissection.Methods We searched the CNKI,Wanfang Database,VIP,PubMed,Web of science,Cochrane Library(from inception to January 2019)to identify studies about the risk factors of acute kidney injury after surgery for acute type A aortic dissection.Quality of the included studies was evaluated by Kars-Ottawa scale.The meta-analysis was performed by RevMan 5.3 software.Results A total of 16 case-control studies were included involving 1728 patients.The results of meta-analysis showed that gender(OR=1.58,95%CI 1.31 to 1.89,P<0.001),body mass index(OR=1.05,95%CI 0.66 to 1.45,P<0.001),hypertension(OR=1.58,95%CI 1.10 to 2.26,P=0.010),smoking history(OR=1.71,95%CI 1.12 to 2.61,P=0.010),preoperative serum creatinine level(OR=30.26,95%CI 20.17 to 40.35,P<0.00001),preoperative white blood cell(OR=1.73,95%CI 0.26 to 3.20,P=0.020),extracorporeal circulation time(OR=25.60,95%CI 21.13 to 30.08,P<0.00001),aortic occlusion time(OR=13.24,95%CI 10.27 to 16.22,P<0.001),deep hypothermic circulatory arrest(DHCA)time(OR=2.58,95%CI 0.86 to 4.29,P=0.003),arch replacement(OR=2.31,95%CI 1.31 to 4.07,P=0.004),intraoperative blood transfusion(OR=1.27,95%CI 0.29 to 2.24,P=0.010),postoperative mean arterial pressure(OR=–2.41,95%CI–4.59 to–0.24,P=0.030),reoperation due to postoperative hemorrhage(OR=4.19,95%CI 2.04 to 8.63,P<0.001),postoperative acute respiratory insufficiency(OR=6.61,95%CI 3.21 to 13.60,P<0.001),postoperative mechanical ventilation time(OR=48.51,95%CI 21.94 to 75.09,P<0.001)were associated with acute kidney injury after surgery for acute type A aortic dissection.Conclusion Current evidence shows that gender,body mass index,hypertension,smoking history,preoperative serum creatinine level,preoperative white blood cell,extracorporeal circulation time,aortic occlusion time,deep hypothermic circulatory arrest(DHCA)time,arch replacement,intraoperative blood transfusion,postoperative mean arterial pressure,postoperative hemorrhage reoperation,postoperative acute respiratory insufficiency and postoperative mechanical ventilation time were risk factors for acute kidney injury after surgery for type A aortic dissection.Medical staff can strengthen perioperative management of patients with acute type A aortic dissection combined with the above factors,so as to reduce the incidence of acute kidney injury after operation and improve the clinical prognosis of patients.
作者
余金甜
陈俊杉
张爱琴
YU Jintian;CHEN Junshan;ZHANG Aiqin(Department of Intensive Care Unit,Jinling Hospital Affiliated to Medical College of Nanjing University(Eastern Theater General Hospital),Nanjing,210002,P.R.China;The Outpatient Department,Jinling Hospital Affiliated to Medical College of Nanjing University(Eastern Theater General Hospital),Nanjing,210002,P.R.China)
出处
《中国胸心血管外科临床杂志》
CAS
CSCD
2020年第1期77-84,共8页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
基金
2016年国家临床护理重点专科项目(2016ZDZK001)
