单纯瓣膜置换术后并发急性肾损伤的危险因素分析

摘要

Objective: To analyze the risk factors of acute kidney injury (AKI) after isolated heart valve prosthesis implantation (HVPI) in relevant patients. Methods: We retrospectively studied 400 patients who received isolated HVPI in our hospital. The demographic characteristics and pre-, intra-, post-operative information were collected to conduct uni- and multi-variantanalysis. Results: The pre-operative serum creatinine level in 400 patients was 85.0 (72.0, 98.0) μmol/L and post-operative level was 104.5 (80.0, 146.3) μmol/L, the elevation was 20.9% (1.6%, 57.9%),P<0.05. Multi Logistic regression analysis indicated that age>50years (OR=2.12, 95% CI 1.13-3.95),hypertension history (OR=4.07, 95% CI1.23-13.47), cardiopulmonary bypass time>180 minutes (OR=5.38, 95% CI 1.63-17.77), post-operative hemoglobin<70 g/L (OR=0.20, 95% CI 0.06=0.74), serum glutamic-pyruvic transaminase>100 u/L (OR=12.10, 95% CI 2.28-64.23), pleural fluid drainage at the day of operation> 500 ml (OR=2.12, 95% CI 1.13-3.95), extubation after 24 hours of operation (OR=3.94, 95% CI 2.07-7.52), combining low cardiac output syndrome (OR=4.64, 95% CI 1.06-20.29) were the independent risk factors for AKI occurrence in patients after HVPI, allP<0.05. Conclusion: Post-HVPI AKI was associated with many factors. At prior operation, it was mainly related to the age and hypertension; during theoperation, it was mainly related to cardiopulmonary bypass time; at post-operation, it was mainly related to delayed extubation, low cardiac outputsyndrome, anemia, increased pleural lfuid drainage and serum glutamic-pyruvic transaminase.%目的：分析单纯瓣膜置换术（HVPI）后并发急性肾损伤（AKI）危险因素。方法：回顾性分析我院心外科接受HVPI的400例患者。根据RIFLE标准，所有患者根据有无AKI将患者分为急性肾损伤组（AKI组，n=157）和肾功能正常组（n=243）。记录人口学特征、术前、术中以及术后等多种变量，进行单因素和多因素分析。结果：AKI发生率为39.3%。400例HVPI患者的术前血清肌酐为85.0（72.0，98.0）μmol/L，术后血清肌酐为104.5（80.0，146.3）μmol/L，增高20.9%（1.6%，57.9%），差异有统计学意义（P<0.05）。Logistic多因素分析发现，>50岁（OR =2.12，95%CI ：1.13~3.95）、高血压病史（OR=4.07，95%CI：1.23~13.47）、转机时间>180 min（OR=5.38，95%CI：1.63~17.77）、术后血红蛋白<70 g/L（OR=0.20，95%CI：0.06~0.74,）、血清谷丙转氨酶>100 U/L（OR=12.10，95%CI：2.28~64.23）、手术当天胸液引流量>500 ml（OR=2.12，95%CI：1.13~3.95）、手术24 h后拔除气管插管（OR=3.94，95%CI：2.07~7.52）、合并低心排综合征（OR=4.64，95%CI：1.06~20.29）是HVPI术后并发AKI的独立危险因素（P均<0.05）。结论：HVPI后AKI是多因素造成的，术前主要与年龄、高血压有关，术中主要和转机时间有关，术后主要和延迟拔管、低心排综合征、贫血、胸液引流量增多以及谷丙转氨酶增高有关。