心脏直视手术和急性肾功能衰竭

急性肾功能衰竭是体外循环心脏直视手术后常而严重的并发症之一，死亡率很高。本组发病率为４％，死亡率８２％，作者根据临床实践中的经验与教训。提出了防止急性肾衰发生的措施。加强术后对肾功能的监测和综合性治疗。当肌酐上升４４μｍｏｌ／（Ｌ．ｄ）或达到２００μｍｏｌ／Ｌ时，无论尿量多少，应给予透析治疗，以保护肾功能，防止肌酐对肾脏的毒性和肾血管的收缩作用，使中，轻度肾功能不全不同急性肾功能衰竭发展，从而减少     

体外循环心脏手术后急性肾损伤相关危险因素分析

目的 分析体外循环心脏手术后发生急性肾损伤(AKI)的危险因素及血肌酐(Scr)、尿素氮(BUN)的变化趋势.方法 回顾分析114例体外循环心脏直视手术患者的临床资料,根据基础Scr水平,采用AKI网络推荐标准(AKIN)分为A、B、C、D4个组,绘制四组Scr、Bun的变化趋势图,分析四组患者围手术期各项观察指标,探讨AKI发生的相关危险因素.结果 心脏术后发生AKI患者的Scr、Bun水平经历了1～3 d升高和2～3 d的恢复过程.单因素分析显示,术前Scr正常的患者,基础Scr值、体外循环(CPB)时间、阻断时间、术后总引流量、术后输入红细胞量是心脏术后发生AKI的相关危险因素.多因素回归分析显示,基础Scr值和LVEF＜40％可能是发生AKI的独立危险因素.对于肾功能不全者,术后总引流量是发生AKI的相关危险因素.结论 心脏术后肾功能指标Scr和BUN的变化趋势有一定规律.AKI的发生与多种围手术期危险因素密切相关,基础Scr值与肾功能可能并不一致.对心脏手术患者应加强术前评估和术中、术后监测,预防和减少AKI的发生.     

脓毒症合并急性肾损伤的危险因素及预后分析

目的:观察急诊重症监护室(EICU)脓毒症合并急性肾损伤(AKI)患者的临床特征并分析AKI发生的危险因素及预后。方法:纳入245例脓毒症患者,分为AKI组与非AKI组,比较2组的临床特征及实验室指标。AKI患者依据KDIGO诊断标准进行分级并进行生存分析。结果:245例脓毒症患者中161例发生了AKI,发生率为65.7%。其中,84例(52.2%)AKI患者死亡。多元回归分析显示,年龄、序贯器官衰竭评分(SOFA)、利尿剂使用、脓毒症分级是脓毒症患者并发AKI的独立危险因素。年龄、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)评分和AKI分级是脓毒症并发AKI患者28d死亡的危险因素。结论:EICU中脓毒症合并AKI的发生率和死亡率均较高,AKI的发生及预后与多种因素有关。     

心脏术后发生急性肾损伤的预后危险因素及防治

急性肾损伤（AKI）是心脏术后的严重并发症,是患者病死率增加的独立预后危险因素。本文将其发病率和病死率、发病机制、危险因素、预防及治疗做一综述。     

急诊脓毒症合并急性肾功能损伤患者的危险因素及预后分析

目的：研究急诊脓毒症合并急性肾功能损伤（AKI）患者的临床特征和AKI发生的危险因素,并进一步探讨AKI患者的预后及AKI严重程度对临床预后的影响。材料及方法：2013年3月~2016年5月连续纳入245例脓毒症患者,分为AKI组与非AKI组,比较两组基础的临床特征及实验室检查结果。AKI患者依据KDIGO（the Kidney Disease: Improving Global Outcomes）诊断标准进行分级并进行生存分析。结果：245例脓毒症患者中161例发生了AKI,发生率为65.7%。84例AKI患者死亡,死亡率52.2%。多元回归分析显示,年龄、序贯器官衰竭评分（SOFA）、利尿剂使用、脓毒症分级是脓毒症患者并发AKI的独立危险因素。年龄、急性生理学与慢性健康状况评分系统II（APACHEII）评分和AKI分级是脓毒症并发AKI患者28天死亡的危险因素。结论：年龄、SOFA评分、利尿剂使用、脓毒症分级与脓毒症患者AKI的发生相关,年龄、APACHII评分和AKI分级与脓毒症AKI患者的预后相关。     

急性心力衰竭患者预后的危险因素分析

目的 分析急性心力衰竭(AHF)患者预后的危险因素.方法 回顾性分析2017年5月至2019年4月河北邢台市第三医院心内科诊治的AHF患者86例,依据随访6个月结果将其分为预后不良组(随访期间再入院或死亡)、预后良好组(随访期间未再入院),对比两组基线资料,采用多因素Logistic回归分析法分析AHF患者预后的危险因...     

围手术期急性肾损伤危险因素及防治

急性肾损伤(AKI) 是外科手术患者常见的临床并发症之一,导致住院时间延长及病死率增加。手术类型、围 手术期各种危险因素包括合并症、手术麻醉、药物等均可能影响AKI 的发生和发展。围手术期AKI 的有效防治措施 包括术前对肾脏风险的专业评估、保持围手术期血流动力学稳定、细胞保护药物以及肾脏替代治疗。     

急性心肌梗死患者新发心房颤动的危险因素及预后分析

目的评估急性心肌梗死(AMI)患者新发心房颤动(NOAF)的危险因素,并分析其预后。方法对2017年6月至2018年6月于吉林大学第一医院就诊的435例AMI患者进行分析。NOAF定义为入院时或住院期间心电图上检测到的心房颤动。收集患者的人口统计学、临床、实验室、超声心动图和冠状动脉造影数据。采用多变量逻辑回归分析确定AMI患者NOAF和总死亡率的独立危险因素。结果在435例AMI患者中,有46例NOAF,发生率为10.6%。多变量分析显示,年龄>60岁(OR=1.072,95%CI:1.013～1.124,P=0.025)、左心室射血分数≤40%(OR=4.895,95%CI:1.826～13.605,P=0.004)和左心房直径>40 mm(OR=1.141,95%CI:1.037～1.261,P=0.012)是AMI患者NOAF的独立危险因素。当综合评估住院和随访死亡率(总死亡率)时,NOAF与预后较差相关(15.2%比7.7%,χ~2=4.925,P=0.011)。多变量分析显示,年龄>60岁、糖尿病病史、NOAF和心功能Killip分级Ⅲ/Ⅳ级均为AMI患者总死亡率的独立危险因素(均为P<0.05)。结论老年、左心室收缩功能不全和左心房直径增大是AMI患者NOAF的危险因素,出现NOAF的AMI患者预后较差。     

心脏手术相关性急性肾损伤的研究进展

心脏手术相关性急性肾损伤（cardiacsurgery—associatedacutekidneyinjury,CSA-AKI）是指发生在心脏外科术后的急性肾功能损害,发生率根据诊断标准和手段,以及心脏手术类型的不同,低至5％,高达45％,通常接近30％。继脓毒症之后,体外循环（cardiopuhnoncuybypass,CPB）是肾损伤的第二位致病原因,与冠状动脉造影相关的对比剂肾病则位列第三。     

AMI患者PCI术后发生急性肾损伤的危险因素及对预后的影响

目的 探讨急性心肌梗死（AMI）患者经皮冠状动脉介入治疗（PCI）术后发生急性肾损伤的相关危险因素及对预后的影响。方法 选择我院于2020年1月至2022年6月收治的90例AMI患者作为研究对象,患者均行PCI,记录术后急性肾损伤的发生率,分析AMI患者PCI术后发生急性肾损伤的危险因素,并观察PCI术后半年不良心血管事件的发生情况。结果 90例患者中,PCI术后发生急性肾损伤11例,发生率为12.22%;单因素分析显示,不同年龄、Killip心功能分级、左室射血分数（LVEF）、造影剂剂量、术前肾功能不全、基线肌酐清除率（CCR）,患者PCI术后急性肾损伤的发生率比较,差异有统计学意义（P<0.05）;多因素Logistic回归分析显示,年龄、Killip心功能分级、LVEF、造影剂剂量、术前肾功能不全、基线CCR均是AMI患者PCI术后发生急性肾损伤的危险因素（P<0.05）;PCI术后随访半年,均无死亡患者,发生急性肾损伤的患者不良心血管事件总发生率为45.45%,明显高于未发生急性肾损伤患者的7.59%,差异有统计学意义（P<0.05）。结论 AMI患者PCI...     

心脏术后急性肾功能衰竭的替代治疗

目的　评估肾脏替代治疗对心脏术后急性肾功能衰竭的效果。方法　 1995年 1月至 2 0 0 3年 7月 ,5 4例心脏术后因急性肾功能衰竭接受了肾脏替代治疗 ,其中腹膜透析 2 0例 ,血液透析 15例 ,连续性肾脏替代治疗 19例。结果　 14例患者肾功能恢复出院 ,6例病情好转后自动出院 ,34例死亡。结论　肾脏替代治疗是心脏术后急性肾功能衰竭的一种有效治疗手段 ,应尽早实施。     

体外循环心脏手术后胸腔积液发生率及危险因素分析

目的研究心脏外科体外循环心脏手术后胸腔积液发生率,并分析其相关危险因素。方法选取2012年4月至2013年10月在北京协和医院心外科接受体外循环下心脏手术的患者173例,符合纳入标准的患者共136例,其中男性90例,女性46例。统计患者术前基本信息、术前用药、术前术后化验指标、术前并发症,应用SPSS16．0统计分析软件对统计结果进行分析。结果136例患者中53例手术后发生胸腔积液,发生率为39％。患者术前心功能、房颤、周围血管病,术前应用抗凝药、氯吡格雷、ACEI、抗心律失常药是心脏手术后胸腔积液发生的危险因素。结论体外循环心脏手术后胸腔积液发生率较高。胸腔积液的发生与多种围手术期危险因素相关,应充分重视这些危险因素的评估和预防。     

Incidence and risk factors of delirium in patients after cardiac surgery: Modifiable and non-modifiable factors

BackgroundPost cardiac surgery delirium is a severe complication. This study tried to evaluate the early postoperative delirium risk factors and to identify which of them can be modified in order to optimize perioperative management.MethodsIt is a prospective observational study. 250 consecutive cardiac surgery patients took part in the study. Cardiac surgery, the anesthetic regiment and the postoperative management were standardized. The incidence and the risk factors of the postoperative delirium were analyzed by univariate and multivariate analysis. Delirium was assessed with screening scale – The Confusion Assessment Method for the intensive care unit every 12 h postoperatively.ResultsDelirium developed in 52 patients (20.8%). Univariate analysis of the variables confirmed that older age (p = 0.0001), the higher EuroSCORE II value (p = 0.0001), longer CPB time (p = 0.0001), longer ACC time (p = 0.0001), and the sufentanil dose (p = 0.010) were strongly independently associated with postoperative delirium. The benzodiazepine administration was shown to be an intermediate predictor for developing postoperative delirium (p = 0.055).ConclusionsAdvanced age, higher EuroSCORE II value, longer CPB and ACC times, and higher sufentanil doses during anesthesia were all predictors for the development of postoperative delirium. The only modifiable risk factor was the use of larger doses of sufentanil which is related with the duration of the operation. New preventive strategies and use of reduced dose of sufentanil intraoperatively, or the use of different opioid should be studied and applied in order to reduce the incidence of the postoperative delirium.     

肾功能评分在心脏瓣膜术后急性肾损伤的应用

目的:研究旨在探讨肾脏衰竭危险、肾脏损伤、肾功能衰竭、肾功能丧失及终末期肾病(RIFLE)分级,对我院成年心脏瓣膜手术后患者临床转归的应用价值。方法:收集2006年10月至2007年3月首次行心脏瓣膜手术的成年患者资料。记录患者性别、年龄、手术类型、尿量、血生化指标和临床转归等。按照RIFLE分级在术后对患者进行评分并记录最高分值。结果:465例患者,男性182例(39.1%),女性283例(60.9%),平均年龄(50.0±11.9)岁。住院病死率2.4%。根据RIFLE分级,最终发生不同程度急性肾功能损伤(AKI)的患者共占32.0%;R级、I级和F级4组患者的住院病死率分别为:1.4%、7.7%和16.3%,以F级患者的病死率为最高(P<0.01)。受试者工作特征曲线(ROC)曲线下面积分析RIFLE和死亡之间有很好的相关性。结论:AKI是心脏瓣膜手术后的常见并发症之一,明显增加术后病死率。RIFLE分级对此类患者的预后及住院病死率有较好预测能力。     

冠状动脉旁路移植术后急性肾损伤患者的预后分析——基于多中心的中期随访研究

目的 分析冠状动脉旁路移植术(coronary artery bypass grafting,CABG)后急性肾损伤(acute kidney injury,AKI)患者的中期预后情况.方法 回顾性分析2013年01月至2020年06月在南京市第一医院,江苏省人民医院和上海市第一人民医院行CABG患者的完整住院资料.根...     

Applicability of the Cleveland clinic scoring system for the risk prediction of acute kidney injury after cardiac surgery in a South Asian cohort

BackgroundAcute kidney injury (AKI) after cardiac surgery is a frequent post-operative complication associated with an increased risk of mortality, morbidity and hospital costs. Preoperative risk scores such as the Cleveland Clinic Scoring Tool (CCST) have been validated in Western population group to identify patients at higher risk of AKI and may facilitate preventive strategies. However, the scoring tool has not been validated systematically in a South Asian cohort. We aimed to evaluate the applicability of the CCST in prediction of AKI after open cardiac surgery in a South–Indian tertiary care center.Materials and methodsA retrospective study of all patients who underwent elective open cardiac surgery over a 4 year period from Jan 2012 to Dec 2015 at a single centre were included and relevant details extracted from a comprehensive chart review. The primary outcome was AKI as defined by the Kidney Disease Improving Global Outcomes (KDIGO) criteria. Patients were risk stratified as per the CCST to assess for prediction of AKI into low risk (0–2), intermediate risk (3–5) and high risk (>6) groups.ResultsA total of 276 patients underwent open cardiac surgery with mean age of 51.5 ± 13.06 yrs. This included 177 (64.1%) males and 99 females (35.8%). Overall incidence of AKI was 6.88%. Mean age, gender, BMI, preoperative serum creatinine, diabetes mellitus, chronic obstructive pulmonary disease, cardiopulmonary bypass time was similar in patients who developed AKI vs those who did not have AKI postoperatively. The mean CCST scores were 1.6 in those without AKI, 1.5 in stage 1, 3.0 in stage 2 and 3.4 in stage 3 AKI. Higher risk scores predicted greater risk of AKI. A total of 106 patients (38.4%) were on ACE/ARB, 119 patients (43.1%) received beta-blockers, 110 (39.8%) received diuretics while 144(52.1%) had received preoperative statins. Comparison of drug use between the two groups revealed that preoperative use of ACEI/ARB was associated with highest risk of AKI (p = 0.006). Mortality rate was also high at 15.7% in those with AKI compared to 3.1% in non-AKI group (p = 0.04).ConclusionThe modified CCST was valid in risk identification of patients with severe stage of AKI but did not have strong discrimination for early AKI stages. Preoperative statin use did not protect against AKI in our study, however preoperative ARB/ACEI use was significantly associated with occurrence of postoperative AKI.     

The prognosis and risk factors for acute kidney injury in high-risk patients after surgery for type A aortic dissection in the ICU

BackgroundAcute kidney injury (AKI) is a major complication of cardiac surgery, with high rates of morbidity and mortality. The aim of this study was to identify risk factors for the incidence and prognosis of AKI in high-risk patients before and after surgery for acute type A aortic dissection (TAAD) in the intensive care unit (ICU).MethodsWe performed a retrospective cohort study from April 2018 to April 2019. The primary end points of this study were morbidity due to AKI and risk factors for incidence, and the secondary end points were mortality at 28 days and risk factors for death.ResultsWe enrolled 60 patients, 52 (86.67%) patients developed postoperative AKI, 28 (53.84%) patients died. Preoperative lactic acid level (P=0.022) and cardiopulmonary bypass (CPB) duration (P=0.009) were identified as independent risk factors for postoperative AKI. The 28-day mortality for postoperative patients with TAAD was 46.67%, 53.84% for those with TAAD and AKI, 67.5% for those who required continue renal replacement therapy (CRRT). The risk factors for 28-day mortality due to postoperative AKI for patients requiring CRRT were CPB duration (P=0.019) and norepinephrine dose upon diagnosis of AKI (P=0.037).ConclusionsMorbidity due to AKI in postoperative patients with TAAD was 86.67%, and preoperative lactic acid level and CPB duration were independent risk factors. The 28-day mortality of postoperative patients with TAAD was 46.67%, 53.84% for those with TAAD and AKI, and 67.5% for those requiring CRRT. CPB duration and norepinephrine dose upon diagnosis of AKI may influence patients’ short-term prognosis.     

Acute kidney injury after isolated aortic valve replacement surgery according to risk/injury/failure/loss/end-stage and acute kidney injury network criteria

Background The epidemiology of acute kidney injury after cardiac surgery depends on the definition used. Limited study reports the incidence of acute kidney injury after isolated aortic valve replacement. Methods We retrospectively analyzed clinical data of 165 adults who had isolated aortic valve replacement between Jan- uary 2010 and June 2011 and compared the maximum acute kidney injury stage according to the RIFLE （risk, injury, failure, loss of function, end-stage kidney disease） and AKIN （Acute Kidney Injury Network） criteri- a. Receiver operating curves were used to compare the predictive ability of each AKI definition for the occur- rence of renal replacement therapy. Results The incidence of AKI using the RIFLE and AKIN criteria was 82.4% and 71.5% respectively, but individual patients were classified differently. The area under the receiver operating characteristic curve for renal replacement therapy showed no difference between the RIFLE and AKIN criteria （0.710 vs. 0.703, P 〉 0.05）. Conclusion There is a high incidence of acute kidney injury after isolated aortic valve replacement, and there is no difference between the RIFLE and AKIN criteria for predict- ing renal replacement therapy.