深低温停循环下全主动脉弓置换术后急性肾损伤的危险因素

目的回顾性分析深低温停循环下全主动脉弓置换术患者的临床资料，探索全主动脉弓置换术后急性肾损伤的围术期危险因素。方法通过分析我院2012年6月至2013年6月期间，深低温停循环下行全主动脉弓置换术患者的临床数据，使用RIFLE标准定义急性肾损伤及其损伤程度，将患者分为非急件肾损伤组（肾功能止常组）和急性肾损伤组（包括风险期、损伤期、衰竭期），比较两组患者闻术期各项临床指标，计算患者深低温停循环下令主动脉弓置换术后急性肾损伤的发生率，并通过Logistir回归分析找出急性肾损伤的围术期危险因素．结果共入选130例患者，男性94例（723％），年龄（488±10．0）岁。术后有67例（51．5％）的患者处于损伤期或衰竭期，其中共17例（131％）患者行术后血液透析治疗。多因素Logislic回归分析结果显示：患者年龄（OR=1．055，95％ CI=1．003-1．110，P=0．039）、术前诊断为手动脉夹层（OR=21．770，95％CI=1．888-251．050，P=0014）及刚术期红细胞输入总量（OR=1.108，95％CI=1．002-1．225，P=0046）是全主动脉弓置换术后发牛急性肾损伤的独立危险因素。结论深低温停循环下行全主动脉弓置换术后急性肾损伤的发生率较高，其中需要临床干预的发牛率为51．5％（包括损伤期和衰竭期）。患者年龄、术前诊断为主动脉夹层及围术期红细胞输入总量是全主动脉弓置换术后发生急性肾损伤的独立危险因素。

Risk Factors for Acute Kidney Injury after Total Aortic Arch Replacement under Deep Hypothermic Circulatory Arrest

Objective To analysis the incidence and risk factors tbr acute kidney injury after total aortic arch replacement under deep hypothermic circulatory arrest. Methods We retrospectively analyzed 130 patients undergoing total aortic arch replacement under deep hypothermic circulatory arrest between June 2012 and June 2013. According to the occurrence of acute kidney injury defined by consensus RIFLE（Risk, Injury, Failure, Loss of function, End-stage renal disease） criteria, they were divided into 2 groups, the group of acute kidney injury and the group of non-acute kidney injury. Univariate and multiple logistic regression were used to identify the risk factors for acute kidney injury after total aortic arch replacement under deep hypothermic circulatory arrest. Results Mean age was 48.8：510.0 years; 94（72.3%） were men. 67 （51.5%） had RIFLE scores of l or F, and 17 （13.1%） required dialysis. Multiple logistic regression showed that the age of patients （O111.055, 95% C1-1.003-1.110, P-0.039）, the diagnosis of aortic dissection （OR 21.770, 95% C1-1.888-251.050, P-0.014） and the total requirements of red blood cells （OR-l.108, 95% C1-1.002-1.225, P 0.046） were independent risk factors for acute kidney injury after total aortic arch replacement under deep hypothermic circulatory arrest. Conclusions Independent risk factors for acute kidney injury in patients undergoing total aortic arch replacement under deep hypothermic circulatory arrest were increased age, diagnosis of aortic dissection and total requircments of red blood cells.