摘要
目的探讨心脏手术体外循环患者并发急性肾损伤(acute renal injury,AKI)患者的危险因素,明确术前实验室检查及术中体外循环时间等与AKI的发病率之间的关系。方法选取2017年10月至2018年10月期间在广西医科大学第一附属医院住院接受体外循环患者的临床资料进行回顾性分析。采用Logistic回归分析患者既往史、术前实验室检查、术中体外循环时间等对术后并发AKI的影响。同时分析并发AKI患者术后7 d血清肌酐变化,为术后并发AKI的早期诊断提供帮助。结果共纳入370例体外循环患者。Logistic回归分析结果:有糖尿病基础病史(OR=5.226,95%CI1.084~25.191,P=0.039)、年龄(OR=1.041,95%CI1.018~1.065,P<0.001)的增加、体质量指数(body mass index,BMI)(OR=1.127,95%CI1.043~1.218,P=0.003)升高、尿素氮(OR=1.211,95%CI1.077~1.360,P=0.001)升高、体外循环时间(OR=1.013,95%CI1.006~1.020,P<0.001)延长是体外循环患者术后并发AKI的危险因素。术后7 d分析AKI检出率分别为第1天4.19%(9/215),第2天51.63%(111/215),第3天87.91%(189/215),第4天97.67%(210/215),第5天99.07%(213/215),第6天100%(215/215),第7天100%(215/215)。结论有糖尿病史、年龄、BMI、尿素氮、体外循环时间是体外循环患者并发AKI的危险因素。为降低漏误诊率,对于术后血清肌酐的观察至少应该连续4 d。
Objective To investigate the risk factors of acute kidney injury(AKI)in patients undergoing cardiopulmonary bypass(CPB)during cardiac surgery,and to determine the relationship between preoperative biochemical examination and intraoperative CPB time and the incidence of AKI.Methods From October 2017 to October 2018,the clinical data of cardiopulmonary bypass patients admitted to the First Affiliated Hospital of Guangxi Medical University were analyzed retrospectively.Logistic regression was used to analyze the influence of patients′basic diseases,preoperative biochemical examination and cardiopulmonary bypass time on postoperative AKI.At the same time,the changes of serum creatinine in patients with AKI 7 days after operation were analyzed to provide help for the early diagnosis of AKI after operation.Results A total of 370 patients with cardiopulmonary bypass were included.Logistic regression analysis results:diabetes basic history(OR=5.226,95%CI:1.084-25.191,P=0.039),the increase of age(OR=1.041,95%CI:1.018-1.065,P<0.001),BMI(OR=1.127,95%CI:1.043-1.218,P=0.003),urea nitrogen(OR=1.211,95%CI:1.077-1.360,P=0.001),and CPB time(OR=1.013,95%CI:1.006-1.020,P<0.001)were the risk factors of postoperative AKI in patients with cardiopulmonary bypass.The detection rate of AKI was 4.19%(9/215),51.63%(111/215),87.91%(189/215),97.67%(210/215),99.07%(213/215),100%(215/215)and 100%(215/215)on the first day,the third day,the fourth day,the fifth day,the seventh day,respectively.Conclusion Diabetes history,age,BMI,Urea nitrogen and CPB times are risk factors of AKI patients after CPB.In order to reduce the rate of misdiagnosis,creatinine should be detected for at least 4 consecutive days in clinical observation of post-operative serum creatinine.
作者
林鹏
陈航
潘永青
蒋玲
廖蕴华
Lin Peng;Chen Hang;Pan Yongqing;Jiang Ling;Liao Yunhua(Department of Nephrology,First Affiliated Hospital of Guangxi Medical University,Nanning 530022,China)
出处
《中国综合临床》
2020年第3期250-254,共5页
Clinical Medicine of China
基金
广西科学与技术开发项目(桂科攻1598011-6)。
关键词
体外循环
急性肾损伤
危险因素
减少漏诊
Cardiopulmonary bypass
Acute renal injury
Risk factors
Reduction of missed diagnosis
