摘要
目的探讨成人心脏瓣膜术后早期急性肾损伤(acute kidney injury,AKI)的发生率、危险因素及其对患者早期预后的影响,为心脏瓣膜术后早期AKI的防治提供依据。方法本研究为回顾性分析研究,连续性收集2016年1月至2017年3月在中山大学附属第一医院接受心脏瓣膜手术患者的临床资料,根据2012年改善全球肾脏病预后组织临床指南的AKI定义标准诊断术后早期AKI并进行分期。根据患者术后48 h内是否发生AKI将入选者分为AKI组和非AKI组,比较分析两组患者临床指标的差异。多因素Logistic回归法分析患者术后早期发生AKI的影响因素,分析术后早期AKI患者的预后。结果600例心脏瓣膜术患者入选本研究,非AKI组403例,AKI组197例,心脏瓣膜术后早期AKI的发生率为32.83%。两组患者在接受肾脏替代治疗比例、机械通气时间、重症监护病房(intensive care unit,ICU)住院时间、院内病死比例上的差异均有统计学意义(均P<0.001)。AKI组患者中,Ⅰ期患者160例(81.22%),Ⅱ期33例(16.75%),Ⅲ期4例(2.03%),不同分期的AKI患者住院期间接受肾脏替代治疗比例、机械通气时间、ICU住院时间、院内病死比例上的差异亦有统计学意义(均P<0.05)。多因素Logistic回归分析结果显示,男性、体重指数≥24.0 kg/m^(2)、有心脏手术史、基线血肌酐>115μmol/L、血白蛋白<35 g/L、主动脉阻断时间>90 min、术后入ICU血糖>11.1 mmol/L、术后48 h内最高血糖与术后0 h血糖差值≥2 mmol/L、术后入ICU血乳酸>4 mmol/L和术后48 h内最大血管活性药物评分>9为心脏瓣膜术后早期发生AKI的独立影响因素(均P<0.05)。结论心脏瓣膜术后48 h内AKI发生率>30%,男性、超重/肥胖、有心脏手术史、术前肾功能不全、低蛋白血症、主动脉阻断时间长、术后应激性高血糖、血糖水平波动大、高乳酸血症和使用血管活性药物多是心脏瓣膜术术后早期发生AKI的独立影响因素。心脏�
Objective To investigate the incidence,risk factors and early prognosis of acute kidney injury(AKI)after heart valve surgery in adults,and to provide evidence for the early prevention and treatment of AKI after heart valve surgery.Methods Clinical data of patients undergoing heart valve surgery from January 2016 to March 2017 were collected retrospectively.Early postoperative AKI was diagnosed and staged according to Kidney Disease Improving Global Outcomes(KDIGO)clinical guidelines for AKI.Patients were divided into AKI group and non⁃AKI group according to whether AKI occurred within 48 hours after surgery,and the differences in clinical indexes between the two groups were compared and analyzed.Influencing factors for early postoperative AKI were screened by stepwise multivariate logistic regression.Results A total of 600 patients were enrolled,including 197 patients in the AKI group and 403 patients in the non⁃AKI group.The incidence of AKI was 32.83%.In the non⁃AKI and AKI groups,proportion of renal replacement therapy(RRT)during hospitalization,mechanical ventilation time,intensive care unit(ICU)time and proportion of hospital mortality were different(all P<0.001).In the AKI group,160 patients(81.22%)were in stage I,33 patients(16.75%)were in stageⅡ,and 4 patients(2.03%)were in stageⅢ.The proportion of patients receiving RRT,mechanical ventilation time,ICU time,hospital mortality were also different in patients with AKI of different stages(all P<0.05).Logistic regression analysis results showed that males,body mass index≥24.0 kg/m^(2),previous history of cardiac surgery,baseline serum creatinine>115 mmol/L,albumin<35 g/L,aortic occlusion time(AOT)>90 min,blood glucose in ICU after operation>11.1 mmol/L,the difference between the highest blood glucose within 48 hours after the operation and the blood glucose at 0 h after the operation≥2 mmol/L,blood lactic acid in ICU after operation>4 mmol/L and maximum vasoactive drug score within 48 hours after surgery>9 were independent influencing factors fo
作者
王翠苹
刘云奇
王锐聪
林琳
张宝
张文波
唐白云
Wang Cuiping;Liu Yunqi;Wang Ruicong;Lin Lin;Zhang Bao;Zhang Wenbo;Tang Baiyun(Department of Critical Care Medicine(Cardiothoracic Intensive Care Unit),the First Affiliated Hospital of Sun Yat-sen University,Guangzhou 510080,China;Department of Cardiac Surgery,the First Affiliated Hospital of Sun Yat-sen University,Guangzhou 510080,China;Department of Critical Care Medicine,Shenzhen Fuyong People's Hospital,Shenzhen 518106,China)
出处
《中华肾脏病杂志》
CAS
CSCD
北大核心
2021年第11期881-888,共8页
Chinese Journal of Nephrology
基金
广东省医学科学技术研究基金(A2019566)。
关键词
危险因素
急性肾损伤
预后
心脏瓣膜手术
Risk factors
Acute kidney injury
Prognosis
Heart valve surgery
