摘要
目的探讨常规冠状动脉支架植入手术后急性肾损害（AKI）的风险因素，为临床防治提供依据。方法回顾性分析2007年1月至2011年7月626例冠状动脉支架植入手术的病例，采用Logistic回归模型分析AKI的风险因素。血清肌酐（SCr）130～199μmol／L或矫正的肌酐清除率（eCcr）30—60ml／（min·1．73m2）作为AKI的诊断标准。结果626例冠状动脉支架植入手术的病例中发生AKI93例（14．9％），Logistic回归模型分析AKI的风险因素包括：年龄（OR=1．570，95％CI1．308—1．885）、射血分数（EF）≤30％（OR=11．526，95％CI2．452—54．177）、术中及术后低血压（OR=11．074，95％CI2．439—50．282）、手术时间（OR=1．032，95％CI1．012～1．051）、性别（OR=0．010，95％CI 0．001—0．086）、心功能Ⅲ级与Ⅳ级（OR：0．209，95％C10．059～0．737）、周围血管硬化（OR=0．528，95％C10．286～0．973）、慢性阻塞性肺疾病（OR=0．546，95％C10．304—0．982），术前Cr（OR=1．418，95％CI 1．216～1．654）（P均〈0．05）。结论AKI是冠状动脉支架植入手术后常见的并发症，尤其年龄、EF≤30％、术中及术后低血压及手术时间是术后并发AKI的独立风险因素。
Objective To investigate the risk factors of acute kidney injury （AKI） after intracoronary stent implantation in order to provide the basis for clinical prophylaxis and treatment. Methods Retrospectively analyzed 626 consecutive patients who underwent isolated intracoronary stent implantation in our institution from January 2007 to July 2011. Multivariate logistic regression model was constructed to identify the risk factors for the development of AKI defined as a serum creatinine （SCr） 130 to 199 μmol/L or estimated creatinine clearance（Ccr） 30 to 60 ml/min per 1.73 m2. Results Ninety-three patients of 626 （ 14. 9% ） underwent isolated intracoronary stent implantation developed AKI. The results of the multivariate forward stepwise logistic regression analysis found that risk factors for the development of AKI following isolated intra-coronary stent implantation was associated with age （ OR = 1. 570,95 % CI 1. 308 - 1. 885 ）, ejection fraction （EF） ≤ 30% （ OR = 11. 526,95% CI 2. 452 - 54. 177 ）, hypotension during perioperative and postoperation （ OR = 11. 074, 95% CI 2. 439 - 50. 282） ,operation duration（ OR = 1. 032,95% CI 1. 012 - 1. 051 ） , sex （ OR = O. 010,95% CI 0. 001 - 0. 086）, NYHA class III ＆ IV （ OR = 0. 209,95% （31 0. 059 - 0. 737 ）, peripheral vascular disease （ OR = 0. 528,95 % CI O. 286 - 0. 973 ）, chronic obstructive pulmonary diseases （ OR = 0. 546,95 % CI 0. 304 - 0.982） ,preoperation Cr （OR=1.418,95%CI 1.216 -1.654） （and all P〈0.05）. Conclusion AKI is the common complications after intraeoronary stent implantation, especially age, EF ≤ 30%, hypotension during perioperative and postoperation, operation duration are independent risk factors.
出处
《中国综合临床》
2013年第8期802-805,共4页
Clinical Medicine of China
