中国综合临床
中國綜閤臨床
중국종합림상
CLINICAL MEDICINE OF CHINA
2013年
8期
802-805
,共4页
苗积国%郭瑞光%毛丽君%姚庆龙%郝继生
苗積國%郭瑞光%毛麗君%姚慶龍%郝繼生
묘적국%곽서광%모려군%요경룡%학계생
冠状动脉支架植入术%急性肾损害%风险评估
冠狀動脈支架植入術%急性腎損害%風險評估
관상동맥지가식입술%급성신손해%풍험평고
Intracoronary stent implantation%Acute kidney injury%Risk factor
目的 探讨常规冠状动脉支架植入手术后急性肾损害(AKI)的风险因素,为临床防治提供依据.方法 回顾性分析2007年1月至2011年7月626例冠状动脉支架植入手术的病例,采用Logistic回归模型分析AKI的风险因素.血清肌酐(SCr) 130 ～ 199μmol/L或矫正的肌酐清除率(eCcr)30～60ml/(min·1.73 m2)作为AKI的诊断标准.结果 626例冠状动脉支架植入手术的病例中发生AKI 93例(14.9％),Logistic回归模型分析AKI的风险因素包括:年龄(OR=1.570,95％CI1.308 ～1.885)、射血分数(EF)≤30％(OR=11.526,95％ CI 2.452 ～54.177)、术中及术后低血压(OR=11.074,95％CI2.439 ～ 50.282)、手术时间(OR=1.032,95％ CI 1.012 ～ 1.051)、性别(OR=0.010,95％ CI 0.001 ～0.086)、心功能Ⅲ级与Ⅳ级(OR=0.209,95％CI0.059 ～0.737)、周围血管硬化(OR=0.528,95％CI0.286 ～0.973)、慢性阻塞性肺疾病(OR=0.546,95％ CI 0.304 ～0.982),术前Cr(OR=1.418,95％ CI 1.216 ～1.654)(P均＜0.05).结论 AKI是冠状动脉支架植入手术后常见的并发症,尤其年龄、EF≤30％、术中及术后低血压及手术时间是术后并发AKI的独立风险因素.
目的 探討常規冠狀動脈支架植入手術後急性腎損害(AKI)的風險因素,為臨床防治提供依據.方法 迴顧性分析2007年1月至2011年7月626例冠狀動脈支架植入手術的病例,採用Logistic迴歸模型分析AKI的風險因素.血清肌酐(SCr) 130 ～ 199μmol/L或矯正的肌酐清除率(eCcr)30～60ml/(min·1.73 m2)作為AKI的診斷標準.結果 626例冠狀動脈支架植入手術的病例中髮生AKI 93例(14.9％),Logistic迴歸模型分析AKI的風險因素包括:年齡(OR=1.570,95％CI1.308 ～1.885)、射血分數(EF)≤30％(OR=11.526,95％ CI 2.452 ～54.177)、術中及術後低血壓(OR=11.074,95％CI2.439 ～ 50.282)、手術時間(OR=1.032,95％ CI 1.012 ～ 1.051)、性彆(OR=0.010,95％ CI 0.001 ～0.086)、心功能Ⅲ級與Ⅳ級(OR=0.209,95％CI0.059 ～0.737)、週圍血管硬化(OR=0.528,95％CI0.286 ～0.973)、慢性阻塞性肺疾病(OR=0.546,95％ CI 0.304 ～0.982),術前Cr(OR=1.418,95％ CI 1.216 ～1.654)(P均＜0.05).結論 AKI是冠狀動脈支架植入手術後常見的併髮癥,尤其年齡、EF≤30％、術中及術後低血壓及手術時間是術後併髮AKI的獨立風險因素.
목적 탐토상규관상동맥지가식입수술후급성신손해(AKI)적풍험인소,위림상방치제공의거.방법 회고성분석2007년1월지2011년7월626례관상동맥지가식입수술적병례,채용Logistic회귀모형분석AKI적풍험인소.혈청기항(SCr) 130 ～ 199μmol/L혹교정적기항청제솔(eCcr)30～60ml/(min·1.73 m2)작위AKI적진단표준.결과 626례관상동맥지가식입수술적병례중발생AKI 93례(14.9％),Logistic회귀모형분석AKI적풍험인소포괄:년령(OR=1.570,95％CI1.308 ～1.885)、사혈분수(EF)≤30％(OR=11.526,95％ CI 2.452 ～54.177)、술중급술후저혈압(OR=11.074,95％CI2.439 ～ 50.282)、수술시간(OR=1.032,95％ CI 1.012 ～ 1.051)、성별(OR=0.010,95％ CI 0.001 ～0.086)、심공능Ⅲ급여Ⅳ급(OR=0.209,95％CI0.059 ～0.737)、주위혈관경화(OR=0.528,95％CI0.286 ～0.973)、만성조새성폐질병(OR=0.546,95％ CI 0.304 ～0.982),술전Cr(OR=1.418,95％ CI 1.216 ～1.654)(P균＜0.05).결론 AKI시관상동맥지가식입수술후상견적병발증,우기년령、EF≤30％、술중급술후저혈압급수술시간시술후병발AKI적독립풍험인소.
Objective To investigate the risk factors of acute kidney injury(AKI) after intracoronary stent implantation in order to provide the basis for clinical prophylaxis and treatment.Methods Retrospectively analyzed 626 consecutive patients who underwent isolated intracoronary stent implantation in our institution from January 2007 to July 2011.Multivariate logistic regression model was constructed to identify the risk factors for the development of AKI defined as a serum creatinine (SCr) 130 to 199 μ mol/L or estimated creatinine clearance(Ccr) 30 to 60 ml/min per 1.73 m2.Results Ninety-three patients of 626 (14.9％) underwent isolated intracoronary stent implantation developed AKI.The results of the multivariate forward stepwise logistic regression analysis found that risk factors for the development of AKI following isolated intra-coronary stent implantation was associated with age (OR =1.570,95％ CI 1.308-1.885),ejection fraction (EF) ≤ 30％(OR =11.526,95％ CI 2.452-54.177),hypotension during perioperative and postoperation (OR =11.074,95％ CI 2.439-50.282),operation duration(OR =1.032,95％ CI 1.012-1.051),sex (OR =0.010,95％ CI 0.001-0.086),NYHA class Ⅲ & Ⅳ (OR =0.209,95％ CI 0.059-0.737),peripheral vascular disease (OR =0.528,95％ CI 0.286-0.973),chronic obstructive pulmonary diseases (OR =0.546,95％ CI 0.304-0.982),preoperation Cr (OR=1.418,95％CI 1.216-1.654) (and all P＜0.05).Conclusion AKI is the common complications after intracoronary stent implantation,especially age,EF ≤ 30％,hypotension during perioperative and postoperation,operation duration are independent risk factors.
