CAJ | 학술논문

目的探讨Stanford A型急性主动脉夹层动脉瘤外科手术后发生急性肾损伤(AKI)的围术期危险因素.方法 2010年1月至2011年12月,137例Stanford A型急性夹层动脉瘤患者施行外科手术.其中男106例,女31例,年龄(46.8 ±13.1)岁,体质量(69.9±18.0)kg.以2005年急性肾损伤网络工作小组制定的AKIN诊断标准为术后急性肾损伤的诊断标准.全组患者均在体外循环下施行外科手术,其中深低温停循环+选择性脑灌注下施行大血管手术120例,54例行全主动脉弓置换,66例行右半弓置换.术后维持动脉平均压在80～90 mmHg(1 mmHg =0.133 kPa),及时补充血容量,积极纠正低氧血症及低蛋白血症.对于经内科药物治疗后仍尿少、无尿或血肌酐值持续上升＞ 500 μmol/L者,予行肾脏替代治疗.结果术后早期死亡12例,病死率8.74％.术后第1天发生AKI者76例(55.47％),其中AKI Ⅰ期38例(27.7％),Ⅱ期21例(15.3％),Ⅲ期17例(12.4％).发生AKI者中36例出现急性肾功能衰竭(acute renal failure,ARF),发生率为26.3％,其中34例接受肾脏替代治疗.单因素分析提示术前肌酐、全弓置换术、体外循环时间、术日浓缩红细胞的输注量是术后发生ARF的危险因素,以logistic回归进行多因素分析提示,全弓置换术以及术前肌酐异常是术后AFR的独立危险因素.结论全弓置换术以及术前肌酐异常是急性A型夹层术后AFR的独立危险因素.
목적 탐토Stanford A형급성주동맥협층동맥류외과수술후발생급성신손상(AKI)적위술기위험인소.방법 2010년1월지2011년12월,137례Stanford A형급성협층동맥류환자시행외과수술.기중남106례,녀31례,년령(46.8 ±13.1)세,체질량(69.9±18.0)kg.이2005년급성신손상망락공작소조제정적AKIN진단표준위술후급성신손상적진단표준.전조환자균재체외순배하시행외과수술,기중심저온정순배+선택성뇌관주하시행대혈관수술120례,54례행전주동맥궁치환,66례행우반궁치환.술후유지동맥평균압재80～90 mmHg(1 mmHg =0.133 kPa),급시보충혈용량,적겁규정저양혈증급저단백혈증.대우경내과약물치료후잉뇨소、무뇨혹혈기항치지속상승＞ 500 μmol/L자,여행신장체대치료.결과 술후조기사망12례,병사솔8.74％.술후제1천발생AKI자76례(55.47％),기중AKI Ⅰ기38례(27.7％),Ⅱ기21례(15.3％),Ⅲ기17례(12.4％).발생AKI자중36례출현급성신공능쇠갈(acute renal failure,ARF),발생솔위26.3％,기중34례접수신장체대치료.단인소분석제시술전기항、전궁치환술、체외순배시간、술일농축홍세포적수주량시술후발생ARF적위험인소,이logistic회귀진행다인소분석제시,전궁치환술이급술전기항이상시술후AFR적독립위험인소.결론 전궁치환술이급술전기항이상시급성A형협층술후AFR적독립위험인소.
Objective To analyze the risk factors of postoperative acute renal injury (AKI) for acute Stanford type A aortic dissection in 137 cases.Methods From January 2010 to December 2011,137 patients with acute Stanford type A aortic dissection were received surgical operations in our hospital.There were 106 males and 31 females with their mean age of(46.8 ± 13.1)years and mean weight of (69.9 ± 18.0) kg.The postoperative acute renal injury diagnosis was according to AKIN diagnosis standard of acute kidney injury network working group in 2005.All patients were received surgical repair with cardiopulmonary bypass,including 120 patients with deep hypothermic circulatory arrest and selective cerebral perfusion.Among them,there were 54 cases with total arch replacement and 66 with right half arch replacement.The postoperative managements were include control the patients' mean arterial blood pressure at 80 to 90 mmHg (1 mmHg =0.133 kPa),supplement the blood volume timely,and correction of hypoxia and hypoproteinemia.The patients were received renal replacement therapy if still oliguria after medical treatments,or their blood creatinine raising continually more than 500 μmol/L.Results A total of 12 patients died in hospitalization with a total in-hospital mortality of 8.74％ (12/137).76 cases had AKI in the first day after operations,including 38 cases (27.7％) with stage Ⅰ and 21 cases (15.3％) with stage Ⅱ and 17 cases (12.4％) with stage Ⅲ.There were 36 patients have acute renal failure (ARF) with morbility of 26.3％ (36/137),and 34 patients among them were received renal replacement therapy.Single factor analysis showed that preoperative creatinine,total arch replacement,cardiopulmonary bypasstime,intraoperative day transfusion of concentrated red cells are risk factors of ARF.Logistic regression was used for multivariate analysis showed that total arch replacement and preoperative creatinine abnormalities are independent risk factors for postoperative AFR.Conclusion Total arch replacement and preoperative creatinine abnormalities were independent risk factors of AFR for acute type A dissection after operation.