全弓置换术后行肾脏替代治疗的危险因素分析及预测

目的 识别全弓置换术后行肾脏替代治疗(renal replacement therapy,RRT)的危险因素.方法 回顾性分析广州军区广州总医院心脏外科中心2007年3月至2017年3月诊断为I型主动脉夹层并行全弓置换的患者258例[男性215例,女性43例,年龄(47.78±8.81)岁].术后肾功能损伤严重需行RRT 46例为RRT组,未行RRT者纳入非RRT组(n=212),回顾围手术期数据,采用单因素分析得出危险因素并纳入Logistic回归明确独立危险因素,并根据ROC曲线下面积对所得危险因素预测的准确性进行判断.结果 RRT组与非RRT组单因素分析可得术前脓毒血症、双侧肾动脉累及、术前血清肌酐、手术时间、体外循环时间、术中红细胞输注量＞ 10 U为全弓置换术后RRT的危险因素,而经Logistic回归分析进一步明确术前血清肌酐(OR:1.018;95％ CI:1.008 ～1.027;P ＜0.001),手术时间(OR:1.034;95％CI:1.005 ～1.064;P=0.020)以及术中红细胞输注＞10 U(OR:3.426;95％CI:1.573 ～7.458;P =0.002)为术后RRT的独立危险因素.ROC曲线分析得出,综合3项危险因素所得的曲线下面积为0.839,95％ CI:0.786 ～0.892,P＜0.001.结论 术前肌酐水平、手术时间以及术中红细胞输注量为全弓置换术后RRT的独立危险因素.

Risk factors and prediction of renal replacement therapy after total arch replacement: report of 258 cases

Objective To identify the risk factors for renal replacement therapy (RRT) following total arch replacement.Methods A total of 258 patients (215 males and 43 females,at a mean age of 47.78-±8.81 years) with type Ⅱ aortic dissection undergoing total arch replacement at the cardiovascular surgery department of Guangzhou General Hospital of Guangzhou Military Command from March 2007 to March 2017 were collected and retrospectively analyzed.Forty-six patients having to receive RRT due to severely damaged renal function were assigned into the RRT group,and the other patients were included in the nonRRT group (n =212).The perioperative data were reviewed.Risk factors were identified by univariate analysis and further confirmed by Logistic regression.The predictive values of identified risk factors were evaluated based on the area under the receiver operating characteristic (ROC) curve.Results Univariate analysis identified preoperative sepsis,bilateral renal artery dissection,preoperative serum creatinine level,operation time,cardiopulmonary bypass time,intraoperative red blood cell infusion ＞ 10 units were risk factors for RRT after total arch replacement.Logistic regression analysis further identified preoperative serum creatinine level (OR =1.018,95％ CI:1.008 ～ 1.027,P ＜0.001),operation time (OR =1.034,95％ CI:1.005 ～ 1.064,P =0.020) and intraoperative red blood cell infusion ＞ 10 units (OR =3.426,95％ CI:1.573 ～7.458,P =0.002) as independent risk factors.ROC curve analysis showed that the area under the curve of the 3 risk factors was 0.839,and 95％ confidence interval was 0.786 to 0.892 (P＜0.001).Conclusion Preoperative creatinine level,operation time and intraoperative red blood cell infusion are independent risk factors for RRT after total arch replacement.