心脏外科手术后并发急性肾损伤276例回顾性分析

目的分析心脏外科手术治疗后并发急性肾损伤(acute kidney injury,AKI)的可能原因,并初步探讨其预后。方法对2002年1月至2010年1月期间在广东省人民医院行心脏外科手术后并发AKI的276例患者的临床资料进行回顾性分析,设为观察组;同时,配对抽取同期行心脏外科手术治疗,术后未并发AKI的患者300例设为对照组。对两组间差异有统计学意义的研究指标再进行Logistic回归多因素分析。结果单因素,多因素联合分析结果显示,患者术后并发AKI的原因与患者术前肾功能状况差(OR=0.01,95%CI:0.000～0.474)、术前心功能分级差(OR=1.67,95%CI:0.195～14.389)、术后出血量多(OR=0.98,95%CI:0.981～0.996)、术后机械通气时间长(OR=0.68,95%CI:0.556～0.832)、术后合并肺部并发症(OR=0.00,95%CI:0.000～0.178)以及术前合并有糖尿病(OR=0.00,95%CI:0.000～0.067)相关。结论 AKI是心脏外科术后一个灾难性的并发症,防重于治;对围手术期评估为高危的患者更应重视AKI的预防。

Retrospective analysis of 276 patients with acute kidney injury after cardiac surgery

Objectives To analyze the cause and prognosis of acute kidney injury （AKI） after cardiac surgery. Methods Retrospective analysis of 276 patients with AKI after cardiac surgery in Guangdong General Hospital from January 2002 to January 2010 was carried out. These patients were in observe group. At the same time, 300 patients accepted cardiac surgery without AKI during the same period were extracted as control group. Research indexes which had significant differences between the two groups were analyzed by logistic regression. Results Preoperative renal function in poor condition （OR=0.01, 95% CI： 0.000-0.474）, preoperative cardiac function grading difference （OR= 1.67, 95% CI： 0.195-14.389）, postoperative over bleeding （OR=0.98, 95% CI： 0.981-0.996）, long duration of mechanical ventilation after surgery （ OR =0.68, 95 % CI ： 0.556-0.832 ）, postoperative pulmonary complications （ OR = 0.00, 95% CI： 0.000-0.178） and preoperative diabetes （OR=0.00, 95% CI： 0.000-0.067） were positive correlated with AKI after cardiac surgery. Conclusions AKI is a disastrous complication after cardiac surgery. To prevent is more important than to treat for AKI. Patients evaluated with high risk during preoperative period should be paid more attention to preventing AKI.