| 心脏瓣膜术后急性肾损伤发生的危险因素分析 |
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| 引用本文： | 唐渊,,王伟,宋昱,.心脏瓣膜术后急性肾损伤发生的危险因素分析[J].天津医科大学学报,2021,0(3):247-251. |
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| 作者姓名： | 唐渊 王伟 宋昱 |
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| 作者单位： | 1.天津医科大学心血管病临床学院，天津 300072；2.天津泰达国际心血管病医院ICU，天津 300457 |
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| 摘 要： | 目的:分析心脏瓣膜手术后急性肾损伤（AKI）发生的危险因素。方法:回顾性分析696例择期行心脏瓣膜手术患者的临床资料，根据是否发生AKI分为AKI组（111 例）和非AKI组（585例）。对术后患者AKI发生的可能相关危险因素先进行单因素分析，再进行Logistic二元回归分析。结果:与非AKI组比较，AKI组年龄更大（t=6.020，P=0.003）、合并糖尿病的更多（χ2 =11.941，P=0.001）、术前心功能更差（t=5.911，P=0.014）、同期行搭桥手术的更多（χ2 =19.399，P=0.000）、体外循环时间更长（t=4.518，P=0.000）、主动脉阻断时间更长（t=3.115，P=0.000）、呼吸机应用时间更长（t=10.141，P=0.000）、肺炎发生率更高（χ2=76.872，P=0.000）、术后输血率更高（χ2=38.954，P=0.000）、ICU住院时间更长（t=4.577，P=0.000）、术后30 d内死亡率更高（χ2=42.520，P=0.000）。Logistic回归分析显示:术前左心室射血分数（LVEF）<40%（OR=4.338，95%CI:2.149～8.753）、呼吸机应用>72 h（OR=8.846，95%CI:4.621～16.933）、术中输血（OR=3.774，95%CI:2.024～7.040）、术后肺炎（OR=3.302，95%CI:1.152～9.467）是心脏瓣膜手术后患者发生AKI的独立危险因素。结论:术前LVEF<40%、术中输血、术后肺炎、呼吸机应用时间延长是心脏瓣膜术后AKI发生的独立危险因素，显著增加术后30 d死亡率。
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| 关 键 词： | 心脏瓣膜手术 急性肾损伤 危险因素 |
Risk factors of acute kidney injury after cardiac valve operation |
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| TANG Yuan,' target="_blank" rel="external">,WANG Wei,SONG Yu,' target="_blank" rel="external">.Risk factors of acute kidney injury after cardiac valve operation[J].Journal of Tianjin Medical University,2021,0(3):247-251. |
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| Authors: | TANG Yuan " target="_blank">' target="_blank" rel="external"> WANG Wei SONG Yu " target="_blank">' target="_blank" rel="external"> |
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| Affiliation: | 1.The Clinical College of Cardiovascular Disease, Tianjin Medical University, Tianjin 300072, China;2.Department of ICU, TEDA International Cardiovascular Hospital, Tianjin 300457, China |
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| Abstract: | Objective: To analyze the risk factors of acute kidney injury（AKI） after cardiac valve surgery. Methods: The clinical data of 696 patients undergoing cardiac valve surgery were retrospectively analyzed. According to the occurrence of acute kidney injury，they were divided into AKI group（111 cases）and non AKI group（585 cases）. The risk factors of AKI were analyzed by univariate analysis and Logistic binary regression analysis. Results: Compared with non AKI group, AKI group had statistically significant differences in the following aspects（P<0.05）: older age（t=6.020，P= 0.003），more diabetes mellitus（χ2=11.941, P=0.001），worse preoperative cardiac function, NYHA Ⅲ-Ⅳgrade（t=5.911，P=0.014）， more patients underwent bypass surgery at the same time（χ2=19.399，P=0.000）， longer cardiopulmonary bypass time（t=4.518，P=0.000）， longer aortic occlusion time（t=3.115，P=0.000）， longer ventilator use time（t=10.141，P=0.000）， higher incidence of pneumonia（χ2=76.872，P=0.000）， higher postoperative blood transfusion rate（χ2=38.954，P =0.000）， longer ICU stay（t=4.577，P=0.000），and the mortality within 30 days after operation was higher（χ2=42.520，P=0.000）. Logistic regression analysis showed that preoperative LVEF<40%（OR=4.338，95%CI:2.149-8.753），ventilator application > 72 h（OR=8.846，95%CI:4.621-16.933），intraoperative blood transfusion（OR=3.774，95%CI:2.024-7.040），postoperative pneumonia（OR=3.302，95%CI:1.152-9.467） were independent risk factors for AKI in patients after cardiac valve surgery. Conclusion: Preoperative LVEF < 40%， intraoperative blood transfusion， postoperative pneumonia and prolonged ventilator use are independent risk factors for AKI after heart valve surgery，which significantly increase 30 day mortality. |
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| Keywords: | cardiac valve surgery acute kidney injury risk factors |
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