Stanford A型主动脉夹层术后急性肾损伤的影响因素

摘要

目的 探讨Stanford A型主动脉夹层术后发生急性肾损伤(AKI)的影响因素.方法 2009年9月至2011年12月,176例Stanford A型主动脉夹层患者中男115例,女61例;年龄28 ～75岁,平均(43.20±10.14)岁.手术采用深低温停循环选择性脑灌注技术.采用AKI网络推荐标准,按照术后是否发生AKI分为AKI组78例和非AKI组98例.分析两组围手术期的各项指标,总结AKI发生的相关因素.结果 本组术后AKI发病率44.32％(78/176例),其中21例需要肾脏替代治疗.住院期间死亡6例,住院病死率3.41％.AKI组死亡5例,非AKI组死亡1例.与非AKI组相比,AKI组死亡风险增加5.28倍(P＜0.01).结论 年龄每增加10岁、术前肾功能不全、左心功能不全、CPB＞ 140 min是Stanford A型主动脉夹层术后发生AKI的独立危险因素,应加强围手术期肾功能保护.%Objective To determine the risk factors for acute kidney injury following type Stanford A Aortic Dissection surgeryies.Methods It's a restrospective study.The clinical data of 176 patients undergoing type Stanford A Aortic Dissection surgery from Septerary 2009 to December 2011 were retrospectively analyzed.There were 115 males and 61 females with mean ages(43.20 ± 10.14)years old.The patients were divided into two groups according to whether AKI occurred after operation.Univariate and multivariate analyses were used to evaluate possible pre-,intra-,and post-operative parameters associated with AKI according to AKI Network.Results Among all the patients,AKI occurred in 78 (44.32％),21 (11.93％) of whom underwent continuous renal replacement therapy (CRRT).In hospital mortality was 3.41％ in all discharges while 6.45％ in AKI patients (P ＜ 0.01).Conclusion Multivariate Logistic regression analysis revealed that increased age,pre-operative left ventricular insufficiency,pre-operative renal insufficiency and long extracorpeal circulation (CPB) time ＞ 140 min were risk factors for the development of AKI.AKI is the most common complication of type Stanford A Aortic Dissection surgery,and is the risk factor of mortality after the surgery.It is important to enhance peri-operative protection of the renal function.