摘要
目的探讨冠状动脉支架植入术后急性肾损伤（acutekidneyinjury，AKI）的危险因素及预后。方法回顾性分析2010年1月至2011年3月在南京大学医学院附属鼓楼医院行冠状动脉支架植入术的325例患者临床资料，排除部分资料不完整的患者。根据术后7d内符合急性肾损伤诊断的标准将入选患者分为对照组（n=274）和AKI组（n=51）。观察指标：（1）术前指标，包括年龄、性别、基础疾病（高血压、糖尿病、脑血管疾病、左心功能不全、周围血管病变）、肌酐、尿素氮、肾小球滤过率（eGFR）、高尿酸血症，蛋白尿、急诊手术、水化、用药（ACEI／ARB、他汀类）；（2）术中指标，包括造影剂剂量、手术时间、低血压；（3）术后指标，包括低血压。采用单因素分析及Logistic多元回归分析，最终筛选出冠状动脉支架植入术后AKI的独立危险因素。并且统计术后AKI的发生率以及分析预后。结果冠状动脉支架植入术后有5l例患者出现AKI，发生率为15．7％；AKI患者的住院时间明显延长（P〈0．01）、病死率明显升高（P〈0．05）。单因素分析提示：（1）术前指标：年龄、基础疾病（左心功能不全、周围血管病变）、肌酐、尿素氮、eGFR、高尿酸血症，蛋白尿、急诊手术、术前水化等指标差异均具有统计学意义（P〈0．05）；（2）术中指标：手术时间、低血压发生率的差异均具有统计学意义（P〈0．05）；（3）术后指标：低血压发生率差异具有统计学意义（P〈0．05）。多因素Logistic逐步回归分析显示：年龄≥65岁（OR=0．253）、术前蛋白尿（OR=5．351）、术前左心功能不全（OR：8．704）、术前eGFR≤60ml／（min·1．73m2）（OR=6．677）、手术时间延长（OR=1．017）、术中低血压（OR：25．245）是冠状动脉支架植入术后发生急性肾损伤的独立危险因素（P〈0．05）。结论AKI是冠状动�
Objective To investigate the risk factors and outcomes of acute kidney injury （AKI） in patients after intra-coronary stent implantation. Methods A retrospective and ease control study was done with data analysis in 325 patients who underwent intra-coronary stent implantation from January 2010 to March 2011. The patients were divided into two groups as per the criteria of AKI identified on the 7th day after implantation of stent. The variables to be studied included ： （ 1 ） age, gender, hypertension, diabetes,cerebrovascular disease, left ventricular insufficiency, peripheral angiopathy, creatinine, urea nitrogen, estimated glomerular filtration rate, hyperuricemia, proteinuria, emergency operation, hydration, and medication （ACEI/ARB, statins ） before operation; （2） dose of contrast media, operation time, hypotension during intra-operative period; and （3） postoperative： hypotension. The variables were analyzed with the process of One-way ANOVA and multivariate Logistical regression analysis. Consequently, the independent risk factors of AKI in patients after intra-coronary stent implantation could be found. Further, the prognosis of AKI patients was analyzed. Results Of the 325 patients, 51 （ 15.7% ） developed AKI. Compared the normal group, hospital stay （ P 〈 0. 01 ） and in-hospital mortality （ P 〈 0. 05 ） increased significantly in the AKI group. Monofactorial analysis showed that age, pre-operative laboratory and clinical data including left ventricular insufficiency, peripheral angiopathy, creatinine, urea nitrogen, estimated glomerular filtration rate, hyperuricemia, proteinuria, hydration and emergency operation, and intra- operative information such as operation time and hypotension, and postoperative hypotension in AKI patients group were significantly different in comparison with control group （P 〈 0.05 ）. Multivariate logistic regression analysis revealed that elderly age （ OR = 0. 253 ）, pre-operative proteinuria （ OR = 5.351 ）, pre- operative left
出处
《中华急诊医学杂志》
CAS
CSCD
北大核心
2012年第5期514-518,共5页
Chinese Journal of Emergency Medicine
