乌司他丁对心脏手术相关性急性肾损伤保护作用的研究

摘要

Objective To investigate the protective effects of urinary trypsin inhibitor ulinastatin on cardiac surgery-associated acute kidney injury ( CSA -AKI ) in patients undergoing heart surgery with cardiopulmonary bypass (CPB).Methods A retrospective, propensity score matched cohort study was used to evaluate the prognosis of 1,243 patients treated with ulinastatin during cardiac surgery with CPB.Then, a multivariate logistic regression model was em-ployed to determine the association between ulinastatin and the incidence of CSA-AKI.Results The control group pro-duced higher incidence of CSA-AKI (40.83%vs.30.32%, P=0.002) and required more frequent use of renal re-placement therapy (RRT) (2.44%vs.0.49%, P=0.02), compared with the ulinastatin group.However, no signifi-cant differences were shown in mortality, the length of stay ( LOS) in intensive care unit ( ICU) and length of hospital stay between the two groups (P>0.05).According to multivariate logistic regression analysis, administration of ulinasta-tin played a protective role in the protection and treatment of CSA-AKI ( OR 0.725, 95%CI 0.561 -0.924, P=0.006).Conclusions Clinical use of ulinastatin can decrease the risk of CSA-AKI in patients during cardiac surgery with CPB and improve their prognosis.%目的：探讨尿胰蛋白酶抑制剂乌司他丁（ ulinastatin）对体外循环（ CPB）下心脏手术相关性急性肾损伤（ CSA－AKI）的保护作用。方法应用倾向评分匹配后的回顾性队列研究评价1243名心脏手术患者的预后，构建logistic回归模型，探讨使用乌司他丁与CSA－AKI发生间的关系。结果与乌司他丁组相比，对照组的CSA－AKI发生率和肾脏替代治疗（ RRT）使用率更高（ CSA－AKI发生率，40．83％vs．30．32％，P＝0．002；RRT使用率，2．44％vs．0．49％，P＝0．02），但2组间的术后病死率、ICU入住时间及住院时间差异无统计学意义（P＞0．05）。logistic回归分析发现，乌司他丁临床应用是防治CSA－AKI的一个保护因素（ OR 0．725，95％CI 0．561－0．924，P＝0．006）。结论临床使用乌司他丁可以降低CPB心脏手术患者CSA－AKI发生风险，可改善患者预后。