CAJ | 학술논문

目的观察心脏手术后急性肾损伤(AKI)的发病危险因素及预后影响因素.方法前瞻性收集2009年4月至2011年5月住院接受心脏外科手术治疗患者资料,包括人口统计学资料、术前一般情况、手术类型、围手术期情况及预后等.结果共纳入4007例心脏手术患者,死亡77例(1.9％),术后发生AKI 1250例,发病率为31.2％,接受肾脏替代治疗(RRT)者104例,RRT治疗率2.6％；AKI组院内病死率显著高于非AKI组(5.4％比0.3％,P＜0.01)；AKI后接受RRT(AKI-RRT)患者院内病死率36.5％ (38/104).心脏移植术后AKI发病率最高(73.0％)、院内病死率最高(18.9％),其次为冠状动脉(冠脉)旁路移植术联合瓣膜手术(AKI发病率57.8％、院内病死率6.1％)、主动脉瘤手术(AKI发病率52.1％、院内病死率5.5％).Logistic多因素回归分析显示:男性、年龄、BMI、高血压、慢性心力衰竭、术前血肌酐＞106.0 μmol/L、术中心肺旁路时间、术中低血压、主动脉瘤手术为心脏手术后AKI发生的独立危险因素；术前血肌酐＞106.0 μmol/L、术中低血压是影响AKI后肾功能完全恢复的独立危险因素,而尿量恢复是肾功能完全恢复的有利因素.结论心脏手术后AKI发病率高、预后较差,其发病与围手术期多种危险因素密切相关.心脏移植术、冠脉旁路移植术联合瓣膜手术及主动脉瘤手术为术后AKI发病的高危手术.
목적 관찰심장수술후급성신손상(AKI)적발병위험인소급예후영향인소.방법 전첨성수집2009년4월지2011년5월주원접수심장외과수술치료환자자료,포괄인구통계학자료、술전일반정황、수술류형、위수술기정황급예후등.결과 공납입4007례심장수술환자,사망77례(1.9％),술후발생AKI 1250례,발병솔위31.2％,접수신장체대치료(RRT)자104례,RRT치료솔2.6％；AKI조원내병사솔현저고우비AKI조(5.4％비0.3％,P＜0.01)；AKI후접수RRT(AKI-RRT)환자원내병사솔36.5％ (38/104).심장이식술후AKI발병솔최고(73.0％)、원내병사솔최고(18.9％),기차위관상동맥(관맥)방로이식술연합판막수술(AKI발병솔57.8％、원내병사솔6.1％)、주동맥류수술(AKI발병솔52.1％、원내병사솔5.5％).Logistic다인소회귀분석현시:남성、년령、BMI、고혈압、만성심력쇠갈、술전혈기항＞106.0 μmol/L、술중심폐방로시간、술중저혈압、주동맥류수술위심장수술후AKI발생적독립위험인소；술전혈기항＞106.0 μmol/L、술중저혈압시영향AKI후신공능완전회복적독립위험인소,이뇨량회복시신공능완전회복적유리인소.결론 심장수술후AKI발병솔고、예후교차,기발병여위수술기다충위험인소밀절상관.심장이식술、관맥방로이식술연합판막수술급주동맥류수술위술후AKI발병적고위수술.
Objective To investigate the risk factors and prognosis influential factors of acute kidney injury (AKI) after cardiac surgery.Methods The clinical data of patients who were hospitalized and underwent cardiac surgery from April 2009 to May 2011 were collected prospectively.Demographic characteristics,types of surgeries,preoperative renal function,pre-and intra-operative conditions and clinical outcomes,etc were recorded.Results A total of 4007 patients underwent cardiac surgery were recruited.The overall incidence of AKI was 31.2％ (1250/4007).The incidence of AKI requiring renal replacement treatment (AKI-RRT) was 2.6％ (104/4007).The overall hospital mortality was 1.9％ (77/4007),and was significantly higher in AKI group than in non-AKI group (5.4％ vs 0.3％,P ＜0.01).The hospital mortality of AKI-RRT group was 36.5％ (38/104).Grouped by type of surgery,cardiac transplantation had the highest AKI incidence (73.0％) and highest in-hospital mortality (18.9％),followed by coronary artery bypass grafting (CABG) combined with valve surgery (AKI incidence 57.8％,in-hospital mortality 6.1％) and aneurysm surgery (AKI incidence 52.0％,in-hospital mortality 5.5％).Multivariate logistic regression analysis showed that man,age,BMI,hypertension,chronic heart failure,pre-operative serum creatinine (SCr) ＞ 106.0 μmol/L,intra-operative cardiopulmonary bypass time,intra-operative hypotension and aneurysm surgery were the risk factors of AKI after cardiac surgery.Multivariate logistic regression analysis showed that pre-operative SCr ＞ 106.0 μmol/L and intra-operative hypotension were independent risk factors of renal recovery after cardiac surgery while recovery of urine output was the favorable factor.Conclusions Cardiac surgery usually induces high AKI incidence and poor prognosis,which closely associated with many risk factors in peri-operative stage.The incidence of AKI is related to a number of perioperative risk factors.Heart transplantation,aneurysm surgery,CABG combined valve surgery are high risk surgeries.