摘要
目的探讨二尖瓣主动脉瓣双瓣置换术后急性肾损伤发生的相关危险因素。方法回顾性分析安徽医科大学附属省立医院2009年1月至2013年12月行二尖瓣主动脉瓣双瓣置换术、年龄≥18岁患者的完整临床资料。通过查阅相关文献筛选可能影响双瓣置换术后出现急性肾损伤的因素,通过单因素和多因素Logistic回归分析方法分析二尖瓣主动脉瓣双瓣置换术后急性肾损伤发生的独立危险因素。结果本组共纳入312例具有完整临床资料的患者,在312例患者中术后急性肾损伤的发生率为19.87%(62/312),其中1期38例,2期18例,3期6例。单因素分析结果表明,二尖瓣主动脉瓣双瓣置换术后急性肾损伤与性别、术前血肌酐值、术后低心排血量综合征、术前7 d内使用对比剂、体外循环时间、主动脉阻断时间、术后呼吸机辅助时间、48 h内再次开胸、合并房颤、术后24 h大量输入库血有关联(P<0.05)。多因素分析结果表明,性别、术前血肌酐值、术后低心排血量综合征、体外循环时间、术后24 h内大量输入库血为心脏瓣膜术后并发急性肾损伤的独立危险因素(P<0.05)。结论性别、术前血肌酐值、术后低心排血量综合征、体外循环时间、术后24 h内大量输入库血为心脏瓣膜术后并发急性肾损伤的独立危险因素。重视患者围术期处理,改善患者术前心、肾功能,缩短体外循环时间,加强术后监护防止低心排血量综合征等可望减少术后急性肾损伤的发生。
Objective To explore the risk factors associated with postoperative acute kidney injury （AKI） in patients undergoing mitral and aortic valve replacement. Methods The clinical data of the patients （age ≥ 18 years） underwent mitral and aortic valve replacement surgery in the A_ffiliated Provincial Hospital of Anhui Medical University from January 2009 to December 2013 were retrospectively studied. The potential risk factors of mitral and aortic valve replacement were searched from the published articles. The independent risk factors of acute kidney injury were analyzed using the Logistic regression analysis. Results Of the patients enrolled, a total of 312 patients in our hospital were included. The rate of postoperative AKI was 19.87% （62/312）, 38 patients in stage 1, 18 patients in stage 2, and 6 patients in stage 3. The univariate analysis showed that the factors associated with AKI were female gender, preoperative serum creatinine, low cardiac output syndrome, contrast media application preoperative within 7 days, duration of cardiopulmonary bypass time, duration of aortic cross-clamping time, postoperative ventilation time, surgical reexploration within 48 hours, atrial fibrillation and massive stored blood transfusion within 24 hours postoperatively. The multivariate analysis showed that the female gender, preoperative serum ereatinine, low cardiac output syndrome, duration of cardiopulmonary bypass and massive stored blood transfusion within 24 hours postoperatively were the independent risk factor of AKI. Conclusions The following ate independent risk factors of AKI： female gender, preoperative serum creatinine, low cardiac output syndrome, duration of cardiopulmonary bypass and massive stored blood transfusion within 24 hours postoperatively. More attention should be paid for preoperative managements of patients, such as~ preoperative medication on improving renal and cardiac function, professional operative skills, improvement of myocardial protective measures, less cardiopulmonary bypass
出处
《中华临床医师杂志（电子版）》
CAS
2015年第11期91-94,共4页
Chinese Journal of Clinicians(Electronic Edition)
关键词
心脏瓣膜假体植入
手术后并发症
肾功能不全
急性
危险因素
Heart valve prosthesis implantation
Postoperative complications
Kidneyinsufficiency, acute
Risk factors
