摘要
目的分析急性Stanford A型主动脉夹层术后患者急性肾损伤(AKI)发生的影响因素。方法根据全球改善肾脏疾病预后(KDIGO)标准,161例急性Stanford A型主动脉夹层患者分为AKI组(73例)和非AKI组(88例),分析急性Stanford A型主动脉夹层术后患者早期发生AKI的可能影响因素。结果单因素分析结果显示,术前心包填塞和高血压患者比例、SBP、MAP、左心室射血分数、体外循环时间、主动脉阻断时间、选择性脑灌注时间以及术后2 h氧合指数和乳酸水平是术后发生AKI的影响因素(P<0.05)。多因素Logistic回归分析显示,术前高血压和心包填塞、体外循环时间超过3 h、术后2 h氧合指数低于150 mmHg是术后发生AKI的独立危险因素(P<0.05)。结论急性Stanford A型主动脉夹层术后AKI的发生率高。术前加强对高血压和心包填塞患者的肾脏保护、缩短体外循环时间、术后及时纠正低氧血症可预防AKI发生,改善患者预后。
Objective To analyze the factors influencing postoperative acute kidney injury(AKI) in the patients with acute Stanford type A aortic dissection.Methods According to the Kidney Disease:Improving Global Outcomes(KDIGO) standard,161 patients with acute Stanford type A aortic dissection were divided into two groups of AKI(73 cases) and non-AKI(88 cases).The possible factors influencing postoperative AKI in the patients with acute Stanford type A aortic dissection were analyzed.Results Univariable analysis demonstrated that the proportion of patients with preoperative cardiac tamponade and hypertension,SBP,MAP,left ventricular ejection function,cardiopulmonary bypass time,aortic crossclamp time,selective cerebral perfusion time and oxygenation index and lactic acid at the 2nd hour after operation were the influencing factors for postoperative AKI(P<0.05).Multivariate Logistic regression analysis showed that preoperative hypertension and cardiac tamponade,cardiopulmonary bypass time>3 hours and oxygenation index at the 2nd hour after operation<150 mmHg were the independent risk factors for postoperative AKI(P<0.05).Conclusion The incidence of postoperative AKI in the patients with acute Stanford type A aortic dissection is higher.Strengthening the renal protection in the patients with hypertension and cardiac tamponade,shortening the cardiopulmonary bypass time and correcting postoperative hyoxemia could effectively prevent AKI and improve prognosis.
作者
薛寅莹
孙芳
章淬
牛永胜
李静
穆心苇
XUE Yinying;SUN Fang;ZHANG Cui(Intensive Care Unit, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, CHINA)
出处
《江苏医药》
CAS
2019年第5期473-476,共4页
Jiangsu Medical Journal
