体外循环心脏手术后急性肾损伤相关危险因素分析

目的 分析体外循环心脏手术后发生急性肾损伤(AKI)的危险因素及血肌酐(Scr)、尿素氮(BUN)的变化趋势.方法 回顾分析114例体外循环心脏直视手术患者的临床资料,根据基础Scr水平,采用AKI网络推荐标准(AKIN)分为A、B、C、D4个组,绘制四组Scr、Bun的变化趋势图,分析四组患者围手术期各项观察指标,探讨AKI发生的相关危险因素.结果 心脏术后发生AKI患者的Scr、Bun水平经历了1～3 d升高和2～3 d的恢复过程.单因素分析显示,术前Scr正常的患者,基础Scr值、体外循环(CPB)时间、阻断时间、术后总引流量、术后输入红细胞量是心脏术后发生AKI的相关危险因素.多因素回归分析显示,基础Scr值和LVEF＜40％可能是发生AKI的独立危险因素.对于肾功能不全者,术后总引流量是发生AKI的相关危险因素.结论 心脏术后肾功能指标Scr和BUN的变化趋势有一定规律.AKI的发生与多种围手术期危险因素密切相关,基础Scr值与肾功能可能并不一致.对心脏手术患者应加强术前评估和术中、术后监测,预防和减少AKI的发生.

The study on risk factors related to acute kidney injury after cardiac surgery with cardiopulmonary bypass

Objective To analysis the changes of serum creatinine and blood urea nitrogen, and determine the risk factors associated with acute kidney injury after cardiac surgery. Methods A retrospective case control study was done in patients who underwent cardiac surgery from December,2011 to November,2012.AU patients were divided into four groups according to the preoperative serum creatinine level and AKIN criteria. The tendency chart of serum creatinine and blood urea nitrogen of four groups were draw and the perioperative period variables were analyzed. Results The level of serum creatinine and blood urea nitrogen had experienced 1-3 days rise phase and 2-3 days decrement phase in patients diagnosed as AKI. For the patients with normal renal function,preoperative serum creatinine,low cardiac output,the duration of CPB, cross-clamp time,total drainage volume and volume of red blood cell transfusion were risk factors for AKI.Variables independently associated with AKI were preoperative serum creatinine and low cardic output.For the patients with renal disfunction, total drainage volume was risk factor for AKI. Conclusion The change of serum creatinine and blood urea nitrogen after cardiac surgery had some regular pattern.AKI is resulted from a series of risk factors.Serum creatinine may not be consistent with actual renal function.Peroperative evaluation and perioperative monitor should be reinforced to prevent and reduce the occurrence of AKI.