AKI网络定义的急性肾损伤在心脏手术后患者中的发生情况及其危险因素和预后分析

目的 了解心脏手术后急性肾损伤（AKI）的发生情况，危险因素及预后。 方法 回顾性分析2004年1月1日至2007年6月30日期间所有在本院行心脏手术的住院患者的临床资料。采用AKI 网络（AKI Network, AKIN）推荐的AKI定义评估心脏手术后AKI的患病率及住院病死率，对术前、术中、术后与AKI发生可能相关的危险因素进行分析。 结果 总共1056例患者中，术后发生AKI者328例，患病率为31.06%。AKI患者的住院病死率显著高于非AKI患者（11.59% 比 0.69%，P < 0.01）。多因素Logistic逐步回归分析显示，高龄（每增加10岁，发生AKI的风险上升1.40倍）、术前高尿酸血症（OR = 1.97）、术前左心功能不全（OR = 2.53）、冠脉旁路移植术（CABG）联合瓣膜手术（OR = 2.79）、手术时间延长（每增加1 h，发生AKI的风险上升1.43倍）、术后循环血容量不足（OR = 11.08）是心脏手术后AKI发生的独立危险因素。 结论 AKI是心脏手术后常见的并发症，AKI患者预后较差。高龄、术前高尿酸血症、术前左心功能不全、CABG联合瓣膜手术、手术时间延长、术后循环血容量不足是心脏手术后AKI发生的独立危险因素。

Incidence of acute kidney injury according to AKI Network after cardiac surgery and analysis of risk factors and outcome

Objective To investigate the incidence, risk factors and outcome of acute kidney injury (AKI) following cardiac surgeries. Methods Clinical data of 1056 patients undergoing open heart surgery in Renji Hospital from January 2004 to June 2007 were retrospectively analyzed. Univariate and multivariate analyses were used to evaluate possible pre-, intra-, and post-operative parameters associated with AKI according to AKI Network (AKIN). Results Of the 1056 patients, 328 (31.06%) developed AKI. In-hospital mortality was 4.07% in all discharges while 11.59% in AKI patients (P<0.01). Multivariate logistic regression analysis revealed that increased age (OR=1.40), pre-operative hyperuricemia (OR=1.97), pre-operative left ventricular insufficiency (OR=2.53), combined surgery (OR=2.79), prolonged operation time (OR=1.43), post-operative circulation volume insufficiency (OR=11.08) were risk factors of AKI. Conclusions AKI is a common complication and associated with increased mortality following cardiac surgery. Increased age, pre-operative hyperuricemia, pre-operative left ventricular insufficiency, combined surgery, prolonged operation time, post-operative circulation volume insufficiency are useful in stratifying risk factors for the development of AKI.