年龄联合术后24h乳酸负荷对心脏瓣膜术后急性肾损伤的预测价值

目的 探讨年龄、术后24h乳酸负荷与成人体外循环心脏瓣膜术后急性肾损伤发生的关系。方法 回顾性收集2019年6月至2020年8月于福建省立医院心血管外科行心脏瓣膜手术的180例住院患者的临床资料，根据术后是否出现急性肾损伤（acute kidney injury,AKI）分为AKI组（n=91）和非AKI组（n=89）。对心脏瓣膜术后AKI发生的危险因素进行单因素及多因素Logistic分析，采用受试者操作特征曲线（receiver operating characteristic curve,ROC曲线）分析各危险因素对心脏瓣膜术后AKI的预测价值。结果 单因素分析结果显示AKI组患者的年龄、体外循环时间、停机乳酸、术后24h液体正平衡量、术后24h乳酸负荷均高于非AKI组，差异均有统计学意义（P<0.05）。多因素分析结果显示年龄、术后24h乳酸负荷是心脏瓣膜术后AKI的独立危险因素（OR值分别为1.064、1.014,P<0.05）。ROC曲线分析显示年龄、术后24h乳酸负荷对心脏瓣膜术后AKI有预测价值，年龄和术后24h乳酸负荷联合指标对心脏瓣膜术后AKI的预测价值...

Predictive value of age combined with postoperative 24-hour lactic acid load for acute kidney injury after cardiac valve surgery

Objective To investigate the relationship between postoperative 24h lactic acid load and acute kidney injury after cardiac valve surgery by cardiopulmonary bypass in adults. Methods The clinical data of 180 patients admitted to Fujian Provincial Hospital for heart valve operation from June 2019 to August 2020 were retrospectively analyzed. They were divided into acute kidney injury (AKI) group (n=91) and non-AKI group (n=89) according to the occurrence of postoperative AKI. Univariate and multivariate Logistic analysis was performed for the risk factors of AKI after heart valve surgery, and receiver operating characteristic (ROC) curve was used to analyze the predictive value of each risk factor for AKI after heart valve surgery. Results Univariate analysis showed that age, time of cardiopulmonary bypass, off-pump lactic acid, postoperative 24h blood loss, postoperative 24h positive fluid balance and postoperative 24h lactic acid load in AKI group were all higher than those in non-AKI group, with statistical significance (P<0.05). The results of multivariate analysis showed that age and postoperative 24h lactic acid load were independent risk factors for AKI after heart valve surgery (OR values were 1.064 and 1.014, P<0.05). ROC curve analysis showed that age and postoperative 24h lactic acid load had predictive value for AKI after heart valve surgery, and the combined indexes of age and postoperative 24h lactic acid load had better predictive value for AKI after heart valve surgery than a single index. Conclusion Age combined with postoperative 24h lactic acid load have better clinical value in predicting acute kidney injury after heart valve surgery.