体外循环心脏手术后急性肾损伤的危险因素分析

摘要

Objective To discuss the risk factors of acute kidney injury (AKI) after cardiopulmonary bypass (CPB).Methods The data was retrospectively analyzed in patients undergone CPB (n=1070, male 570 and female 500) chosen the Department of Cardiac Surgery of Beijing Anzhen Hospital affiliated to Capital University of Medical Sciences from Jan. 2016 to Jun. 2016. All patients were divided into non-AKI group (n=850) and AKI group (n=220). The medical materials of the patients were looked over, and indexes of sex, age, body mass index (BMI), complications, class of New York Heart Association (NYHA), left ventricular ejection fraction (LVEF), preoperative blood routine examinations, kidney function, CPB, operation situation, auxiliary time of mechanical ventilation (MV) and blood transfusion volume after operation for 24 h were recorded.Results The age, percentages of patients with hypertension and diabetes, BMI, NYHA, serum creatinine (SCr), CPB duration, aorta cross-clamp time, blood transfusion volume and bleeding volume during operation, dose of hydroxyethyl starch, blood transfusion volume after operation for 24 h and MV auxiliary time increased, and LVEF, hemoglobin (Hb), and percentages of patients with dexmedetomidine, intra-aortic balloon pumps (IABP), deep hypothermic circulatory arrest (DHCA), CPB ultrafiltration and post-operative hypotension decreased in AKI group compared with non-AKI group (allP<0.05). The results of Logistic regression analysis showed that age≥55 (OR=1.823, 95%CI: 1.594~3.083), hypertension (OR=1.465, 95%CI: 1.254~1.762), preoperative SCr≥79.5 μmol/L (OR=1.331, 95%CI: 1.160~3.249), CPB duration≥110 min (OR=2.104, 95%CI: 1.326~7.340) and post-operative hypotension (OR=1.988, 95%CI:1.358~2.947) were independent risk factors of AKI after CPB, and CPB ultrafiltration (OR=0.655, 95%CI:0.512~0.871) and dexmedetomidine administration (OR=0.573, 95%CI: 0.339~0.901) were.Conclusion Age≥55, hypertension, preoperative SCr≥79.5 μmol/L, CPB duration≥110 min and post-operative hypotension are independent risk factors of AKI after CPB, and CPB ultrafiltration and dexmedetomidine administration are protective factors of AKI after CPB, and physicians should pay more attentions to.%目的 探讨体外循环(CPB)心脏手术后急性肾损伤(AKI)的危险因素.方法 回顾性分析2016年1月~6月于首都医科大学附属北京安贞医院心脏外科收治的1070例CPB心脏手术患者资料,其中男性570例,女性500例.依据术后是否发生急性肾损伤分为非AKI组(n=850)和AKI组(n=220).翻阅患者病历资料,记录患者性别、年龄、体质指数、合并疾病、心功能分级(NYHA)、左室射血分数、术前血常规、肾功能、CPB及手术情况、机械通气辅助时间、术后24 h输血量等资料.结果 与非AKI组比较,AKI组年龄、高血压比例、糖尿病比例、体质指数、心功能分级、肌酐、体外循环转机时间、主动脉阻断时间、术中输血量、术中出血量、使用羟乙基淀粉量、术后24 h输血量、机械通气时间等增加,左室射血分数和血红蛋白水平降低,使用右美托咪啶、主动脉球囊反搏、深低温停循环、CPB超滤的比例以及术后低血压比例减少,差异有统计学意义(P均<0.05).Logistic回归分析结果 显示,年龄≥55岁(OR=1.823,95%CI:1.594~3.083)、高血压(OR=1.465,95%CI:1.254~1.762)、术前肌酐≥79.5μmol/L(OR=1.331,95%CI:1.160~3.249)、体外循环转机时间≥110 min(OR=2.104,95%CI:1.326~7.340)、术后低血压(OR=1.988,95%CI:1.358~2.947)是CPB术后发生AKI的独立危险因素,应用CPB超滤(OR=0.655,95%CI:0.512~0.871)、使用右美托咪啶(OR=0.573,95%CI:0.339~0.901)是保护性因素.结论 年龄≥55岁、高血压、术前肌酐≥79.5μmol/L、体外循环转机时间≥110 min、术后低血压是CPB术后发生AKI的独立危险因素,应用CPB超滤和右美托咪啶是CPB术后发生AKI的保护因素,临床医生应予以重视.