A型主动脉夹层术后急性肾损伤患者接受连续性肾脏替代治疗的预后因素

李洋平; 马峰; 赵丽娟; 赵晋; 柏明; 于艳; 孙世仁

doi:10.12125/j.chj.201909024

A型主动脉夹层术后急性肾损伤患者接受连续性肾脏替代治疗的预后因素

Prognostic factors of patients with Stanford type A aortic dissection receiving CRRT due to AKI post cardiac surgery

摘要

摘要:
目的分析Stanford A型主动脉夹层术后出现急性肾损伤（acute kidney injury, AKI）并接受连续性肾脏替代治疗（continuous renal replacement therapy, CRRT）的患者预后因素。
方法筛选2015年4月 ~ 2018年3月西京医院收治A型主动脉夹层心脏手术后出现AKI并接受CRRT治疗的患者，记录患者术前、术中、术后临床资料，按患者是否存活分为2组:存活组(n = 32)和死亡组(n = 34)。
结果最终纳入66例患者，年龄（49 ± 9）岁，男性占91%，术前血肌酐（144 ± 77）μmol/L。其中，34例患者死亡（52%）。多因素Logistic回归分析表明术中红细胞输注的量（HR = 3.169, 95% CI 1.180 -8.513；P < 0.05）和术后多脏器功能衰竭（HR = 3.575, 95% CI 1.196 -10.687；P < 0.05）是A型主动脉夹层术后出现AKI并接受CRRT的患者死亡独立危险因素。
结论对于A型主动脉夹层术后需要CRRT治疗的AKI患者，术中输注红细胞量越多以及术后出现多脏器功能衰竭患者的死亡风险越大。

Abstract:
AIM To analyze prognostic factors of patients with Stanford type A aortic dissection receiving continuous renal replacement therapy (CRRT) due to acute kidney injury (AKI) post cardiac surgery.
METHODS Patients with AKI receiving CRRT after cardiac surgery for type A aortic dissection in Xijing Hospital from April 2015 to March 2018 were screened. Patients were divided into two groups: survival arm(n = 32), death arm (n = 34), and the clinical data before, during and after operation were recorded..
RESULTS Sixty-six patients were enrolled, with age of 49 (±9) years, 91% of them were males, and the preoperative serum creatinine was 144(±77) μmol/L. Among them, 34 patients died(52%).Multivariate logistic regression analysis showed that intraoperative erythrocyte transfusion (HR = 3.169, 95% CI 1.180-8.513; P <0.05) and postoperative multiple organ failure (HR = 3.575, 95% CI 1.196-10.687; P <0.05) were independent risk factors for death in patients with Stanford type A aortic dissection receiving CRRT due to AKI post cardiac surgery.
CONCLUSION More red blood cells injected during the operation and multiple organ failure after the operation may suggest higher risk of death in AKI patients requiring CRRT after surgery for type A aortic dissection.

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