老年患者心脏瓣膜置换术后急性肾衰竭透析治疗的高危因素分析

目的探讨老年患者心脏瓣膜置换术后急性肾衰竭(ARF)透析治疗的高危因素。方法将年龄>65岁行心脏瓣膜置换术后发生ARF需要透析的43例患者作为透析组,另选年龄同上行心脏瓣膜置换术无需透析的86例患者作为对照组,应用logistic回归进行多因素分析,筛选出心脏瓣膜置换术后ARF需透析治疗的高危因素。结果透析组患者术前NYHA分级、LVEF、肌酐、尿素水平、体外循环时间、术后发生低心排综合征。24h内输入库血量与对照组比较,差异有统计学意义(P<0.05,P<0.01);其中术后发生低心排综合征、体外循环时间与术后ARF需要透析的关系最为密切。结论年龄不是老年患者心脏瓣膜置换术后ARF需透析治疗的高危因素,其发生与术后低心排综合征、体外循环时间关系最为密切,积极防范和应对可以减少这种严重并发症的发生。

High risk factors analysis of dialyzed acute renal failure in elderly patients undergoing valve replacement

Objective To explore the high risk factors for postoperative acute renal failure which needed dialysis in elderly patients who underwent valve replacement.Methods From January 2001 to December 2005,3 052 consecutive patients undergoing valve replacement were enrolled into the study.Of them,97 developed postoperative acute renal failure and needed dialysis.Forty-three cases were elderly patients.Logistic regression analysis was used to screen the high risk factors for postoperative acute renal failure which needed dialysis in elderly patients who underwent valve replacement.Results The high risk factors for postoperative acute renal failure which needed dialysis in elderly patients who underwent valve replacement were:postoperative low cardiac output syndrome,extracorporeal circulation duration,massive reserved blood transfusion within 24 hours postoperatively and blood serum creatinine levels,especially the former two factors.Conclusion Postoperative low cardiac output syndrome and extracorporeal circulation duration are the two major factors which are in closest relationship with the occurrence of postoperative acute renal failure needing dialysis in elderly patients who underwent valve replacement,while age is not the high risk factor.Aggressive precaution and reliable treatment would reduce the incidence of this severe complication.