CAJ | 학술논문

目的探讨心脏手术后急性肾损伤(AKI)患者的远期预后及肾脏转归.方法选2009年4月至2011年2月复旦大学附属中山医院行心脏外科手术治疗的患者,术后依据改善全球肾脏病预后组织(KDIGO)推荐指南的AKI诊断标准分为AKI组与非AKI组,随访2年,记录2年累积生存率及晚期慢性肾脏病(CKD)(4～5期)发病率,分析患者术后2年累积生存率及进展至晚期CKD的影响因素.结果共纳入1 770例心脏术后患者,其中715例患者发生术后AKI,发病率为40.4％.(1)2年累积生存率AKI组(83.2％)低于非AKI组(93.6％;P＜0.05);与非AKI组比,AKI显著增加患者的死亡风险(RR=1.710,95％ CI1.250 ～2.340);多因素Cox回归分析显示:AKI是独立的增加死亡风险的因素,风险强度仅次于糖尿病和慢性心功能不全,高龄、术前合并有慢性心功能不全、糖尿病史、ICU留治时间也显著增加患者的死亡风险.(2)术后2年晚期CKD的发病率AKI组(6.7％)高于非AKI组(0.2％;P＜0.05);与非AKI组比,AKI组发生晚期CKD的RR=31.220,95％ CI7.550 ～ 129.110;多因素Cox回归分析显示:校正其他因素影响,AKI仍是独立的增加晚期CKD发病风险的因素,而术前合并糖尿病史、术中心肺旁路时间、ICU留治时间也会增加晚期CKD的发病风险.结论心脏术后AKI显著增加患者术后2年的死亡风险,并显著增加术后2年晚期CKD的发病率.重视心脏手术后AKI的防治,出院后肾功能的随访与保护,以改善患者的远期预后.
목적 탐토심장수술후급성신손상(AKI)환자적원기예후급신장전귀.방법 선2009년4월지2011년2월복단대학부속중산의원행심장외과수술치료적환자,술후의거개선전구신장병예후조직(KDIGO)추천지남적AKI진단표준분위AKI조여비AKI조,수방2년,기록2년루적생존솔급만기만성신장병(CKD)(4～5기)발병솔,분석환자술후2년루적생존솔급진전지만기CKD적영향인소.결과 공납입1 770례심장술후환자,기중715례환자발생술후AKI,발병솔위40.4％.(1)2년루적생존솔AKI조(83.2％)저우비AKI조(93.6％;P＜0.05);여비AKI조비,AKI현저증가환자적사망풍험(RR=1.710,95％ CI1.250 ～2.340);다인소Cox회귀분석현시:AKI시독립적증가사망풍험적인소,풍험강도부차우당뇨병화만성심공능불전,고령、술전합병유만성심공능불전、당뇨병사、ICU류치시간야현저증가환자적사망풍험.(2)술후2년만기CKD적발병솔AKI조(6.7％)고우비AKI조(0.2％;P＜0.05);여비AKI조비,AKI조발생만기CKD적RR=31.220,95％ CI7.550 ～ 129.110;다인소Cox회귀분석현시:교정기타인소영향,AKI잉시독립적증가만기CKD발병풍험적인소,이술전합병당뇨병사、술중심폐방로시간、ICU류치시간야회증가만기CKD적발병풍험.결론 심장술후AKI현저증가환자술후2년적사망풍험,병현저증가술후2년만기CKD적발병솔.중시심장수술후AKI적방치,출원후신공능적수방여보호,이개선환자적원기예후.
Objective To evaluate the long-term outcome of acute kidney injury (AKI) during hospitalization after cardiac surgery.Methods 1 770 patients underwent cardiac surgery in Fudan University Zhongshan Hospital from April 2009 to February 2011 were enrolled.Based on the Kidney Disease:Improving Global Outcomes (KDIGO) guideline of AKI,the patients were divided into the AKI and the nonAKI groups,and followed up for 2 years.The 2-year survival rate and incidence of the advanced chronic kidney disease (CKD) was compared between the two groups.Factors influencing the 2-year survival rate and incidence of the advanced CKD were also analyzed.Results Among all the patients,715 (40.4％) of them were developed AKT.(1) The 2-year survival rate of the AKI group was lower than that of the non-AKI group (83.2％ vs 93.6％ ;P ＜0.05).Compared with the non-AKI group,AKI group had an increased risk for death with the hazard ratio of 1.710 (95％ CI 1.250-2.340).COX regression analysis showed that AKI was an independent factor for death with the risk intensity just less than diabetes and chronic cardiac insufficiency.The advanced age,the preoperative history of chronic cardiac insufficiency and the time of staying in ICU also significantly increased the risk of death.(2) Compared with patients without AKI (0.2 ％),the incidence of the 2-year of advanced CKD was higher in patients with AKI (6.7 ％ ; P ＜ 0.05) with an hazard ratio of 31.220 (95 ％ CI 7.550-129.110).COX regression analysis showed that AKI was still the independent risk factor for advanced CKD after adjustment of other factors.In addition,diabetes,the time of the cardiopulmonary bypass and the time of staying in ICU were also associated with the risk for the advanced CKD.Conclusions AKI is common after cardiac surgery,which was associated with a decrease in the 2-year survival rate and an increase in the incidence of advanced CKD of patients,which emphasized the importance of prevention and treatment of AKI,and close follow-up of renal function for the improvement of patient long-term prognosis.