陈小兰, 柏明, 孙世仁, 陈香美. A型主动脉夹层术后严重高胆红素血症并发急性肾损伤患者的预后及危险因素[J]. 心脏杂志, 2020, 32(2): 146-150, 155. DOI: 10.12125/j.chj.202001005
    引用本文: 陈小兰, 柏明, 孙世仁, 陈香美. A型主动脉夹层术后严重高胆红素血症并发急性肾损伤患者的预后及危险因素[J]. 心脏杂志, 2020, 32(2): 146-150, 155. DOI: 10.12125/j.chj.202001005
    Xiao-lan CHEN, Ming BAI, Shi-ren SUN, Xiang-mei CHEN. Fatality rate and risk factors of death in Stanford type A aortic dissection patients with severe post-operation hyperbilirubinemia and acute kidney injury[J]. Chinese Heart Journal, 2020, 32(2): 146-150, 155. DOI: 10.12125/j.chj.202001005
    Citation: Xiao-lan CHEN, Ming BAI, Shi-ren SUN, Xiang-mei CHEN. Fatality rate and risk factors of death in Stanford type A aortic dissection patients with severe post-operation hyperbilirubinemia and acute kidney injury[J]. Chinese Heart Journal, 2020, 32(2): 146-150, 155. DOI: 10.12125/j.chj.202001005

    A型主动脉夹层术后严重高胆红素血症并发急性肾损伤患者的预后及危险因素

    Fatality rate and risk factors of death in Stanford type A aortic dissection patients with severe post-operation hyperbilirubinemia and acute kidney injury

    • 摘要:
      目的 探讨A型主动脉夹层术后严重高胆红素血症并发急性肾损伤(AKI)患者的预后及危险因素。
      方法 回顾性筛选西京医院2015年1月~2018年12月行A型主动脉夹层手术治疗的患者,术后同时发生严重高胆红素血症和AKI的患者被纳入研究。研究终点包括住院死亡和长期死亡。采用单因素和多因素分析住院死亡相关的危险因素,使用Kaplan-Meier生存曲线来评估患者的长期生存率以及AKI的不同分期对长期生存的影响。
      结果 221例患者被纳入研究,50例患者接受持续性肾脏替代治疗(CRRT),82例患者住院死亡。1年、2年和3年累积病死率分别是39.0%、40.2%和41.1%。多因素Logistic 回归分析显示,A型主动脉夹层术后严重高胆红素血症并发AKI患者死亡的独立危险因素为:术后第1天平均动脉压(OR0.967,95%CI 0.935-1.000;P<0.01)、术后机械通气时长(OR 1.189,95%CI 1.003-1.410;P<0.05)、术后总输血量(OR 1.019,95%CI 1.003-1.036;P<0.05)以及AKI 3期(OR 12.639,95%CI5.409-34.388;P<0.01)。
      结论 A型主动脉夹层术后严重高胆红素血症并发AKI患者的住院病死率以及长期病死率较高。AKI 3期,术后较低的平均动脉压,延长的术后机械通气以及增加的术后输血量是患者住院死亡的危险因素。因此,临床医生应该更密切地监测具有这些高风险的患者。

       

      Abstract:
      AIM To investigate the prognosis and risk factors of mortality in Stanford type A aortic dissection (AAD) patients with severe post-operation hyperbilirubinemia and acute kidney injury (AKI).
      METHODS Patients who underwent surgery for AAD at Xijing Hospital between January 2015 and December 2018 were retrospectively screened and patients with severe post-operation hyperbilirubinemia and AKI were included in the present study. In-hospital mortality and long-term mortality were assessed as endpoints and univariate and multivariate analyses were performed to identify the risk factors of in-hospital mortality. Kaplan-Meier survival curve was employed to assess the long-term mortality and the long-term mortality of patients with different AKI stages.
      RESULTS Two hundred and twenty one patients were included, of whom 50 received continuous renal replacement therapy (CRRT) and 82 died during their hospital stay. The 1-, 2-, and 3-year accumulated mortality were 39.0%, 40.2% and 41.1%, respectively. Multivariate logistic regression analysis showed that postoperative mean arterial pressure (OR 0.967, 95%CI 0.935-1.000; P = 0.005), postoperative mechanical ventilation time (OR 1.189, 95%CI 1.003-1.410; P = 0.046), total amount of blood transfusion (OR 1.019, 95%CI 1.003-1.036; P = 0.018) and AKI stage 3 (OR 12.639, 95%CI 5.409-34.388; P = 0.01) were independent risk factors of in-hospital mortality.
      CONCLUSION Patients with severe hyperbilirubinemia and AKI after AAD surgery have high in-hospital and long-term mortality. Stage 3 AKI, lower postoperative mean arterial pressure, prolonged postoperative mechanical ventilation time, and increased postoperative blood transfusion volume are associated with increased in-hospital mortality. Patients with these risk factors warrant more intensive monitoring.

       

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