Stanford A型主动脉夹层术后肾脏功能损伤的危险因素

目的调查分析Stanford A型主动脉夹层术后肾脏功能损伤(AKI)的危险因素,为临床降低肾脏功能损伤并发率对策提供支持。方法收集2017年1月—2019年12月医院心血管外科确诊且顺利行A型主动脉夹层手术的179例患者为研究对象,均由同组外科医师和麻醉医师实施手术,术后进入ICU监测治疗。根据术后早期是否存在AKI,将发生AKI 60例设为病例组,未发生AKI 119例设为对照组。分析发生AKI高危因素。结果经过多因素Logistics回归分析显示,年龄(OR=2.396)、双侧肾脏灌注欠佳(OR=8.725)、BMI值(OR=3.454)、监测膀胱温度(OR=4.180)、CPB时长(OR=2.165)、术中红细胞输注(OR=2.291)均为此类手术患者发生AKI独立危险因素(P<0.05)。结论年龄、BMI值、双侧肾脏灌注欠佳、CPB、监测膀胱温度、术中红细胞输注均为影响A型主动脉夹层术后AKI的独立相关因素,临床护士应针对上述分析制定个体化针对方案以降低术后AKI发生风险。

Risk factors of renal function injury after Stanford type A aortic dissection

Objective To investigate and analyze the risk factors of acute kedney injury(AKI) after Stanford type A aortic dissection and provide support for clinical measures to reduce the incidence of renal dysfunction. Methods A total of 179 patients who were diagnosed by the hospital’s cardiovascular surgery and successfully underwent type A aortic dissection from January 2017 to December 2019 were collected as the study objects, and all surgeons and anesthesiologists performed the operations in the same group and they were sent into the ICU for monitoring treatment after the operation. According to whether there was AKI in the early postoperative period, 60 cases with AKI were set as a case group, and 119 cases without AKI were set as a control group to analyze the high risk factors for AKI. Results Multivariate Logistic regression analysis showed that the age(OR=2.396), inadequate bilateral renal perfusion(OR =8.725), BMI value(OR =3.454), monitoring of bladder temperature(OR =4.180), CPB duration(OR =2.165), and intraoperative red blood cell infusion(OR =2.291) were all independent risk factors for AKI in patients with this type of surgery(P<0.05). Conclusion The age, BMI value, inadequate bilateral renal perfusion, CPB, monitoring of bladder temperature, and intraoperative red blood cell infusion were all independent factors affecting AKI after type A aortic dissection. Clinical nurses should develop individualized plans based on the above analysis to reduce the risk of postoperative AKI.