老年患者体外循环心脏手术后急性肾功能损伤及预后危险因素

摘要

目的 分析行体外循环心脏手术后老年患者急性肾损伤(AKI)发生率、预后情况和危险因素.方法 选取2013年7月至2014年5月于首都医科大学附属北京安贞医院行体外循环心脏手术治疗的1 250例老年患者为研究对象.收集患者围术期相关资料,记录AKI发生情况和患者预后情况,分析患者死亡的危险因素.结果 1 250例患者平均年龄(66±5)岁,AKI发生率为33.9％(424/1 250).患者平均随访(10±3)个月,AKI患者病死率明显高于非AKI患者[7.5％ (32/424)比2.7％ (22/826)] (P=0.001).术前合并冠状动脉粥样硬化性心脏病、体外循环时间较长、输入血浆量多和术后发生AKI是患者死亡的独立危险因素(均P ＜0.05).结论 行体外循环心脏手术后老年患者AKI发生率较高,术后发生AKI是患者死亡的独立危险因素.%Objective To analyze the incidence of acute kidney injury(AKI),prognosis and risk factors of death in elderly patients after cardiopulmonary bypass (CPB).Methods A total of 1 250 elderly patients undergoing CPB cardiac surgery were enrolled from July 2013 to May 2014 in Beijing Anzhen Hospital,Capital Medical University.Perioperative data,occurrence of AKI and prognosis were recorded.Risk factors of death were analyzed.Results The mean age of 1 250 patients was (66 ± 5) years.The incidence of AKI was 33.9％ (424/1 250).During (10 ±3)months of follow-up,the mortality rate of AKI patients was significantly higher than that of non-AKI patients [7.5％ (32/424) vs 2.7％ (22/826)] (P =0.001).Coronary heart disease,long-time CPB,large volume of plasma input and postoperative AKI were independent risk factors of death(P ＜ 0.05).Conclusion Elderly patients post CPB have high incidence of AKI,which is an independent risk factor of death.