A型主动脉夹层术后急性肾损伤患者行连续性肾脏替代治疗的危险因素分析

尤针针.A型主动脉夹层术后急性肾损伤患者行连续性肾脏替代治疗的危险因素分析[J].内科急危重症杂志,2024,30(4):313-316

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DOI：10.11768/nkjwzzzz20240406

中文关键词: Stanford A 型主动脉夹层连续性肾脏替代治疗危险因素

英文关键词:

基金项目:河南省医学科技攻关计划联合共建项目（LHGJ20220117;LHGJ20210125）

作者	单位	E-mail
尤针针	阜外华中心血管病医院肾内科河南省人民医院	zhangzhu1127@163.com

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中文摘要:

摘要目的：分析Stanford A型主动脉夹层(AD)术后急性肾损伤(AKI)行连续性肾脏替代治疗（CRRT）患者死亡的危险因素及CRRT介入时机与预后的关系。方法：回顾性选取术后行CRRT的Stanford A型AD合并AKI患者39例,其中生存组18例，死亡组21例。分析2组患者围手术期的各项指标及死亡的危险因素。分析早期（术后48h内）与晚期（术后48h后）行CRRT对患者生存率的影响。结果：2组年龄、性别、体质指数（BMI）、相关病史、血常规、血肌酐、心脏超声检查、体外循环数据、术中失血量、输红细胞悬液量、术后2次开胸止血、术后使用血管活性药物方面比较，差异无统计学意义（P均＞0.05）。年龄（HR=1.115，P=0.01,95%CI：1.046~1.189）及血肌酐（HR=1.013，P=0.035,95%CI：1.006~1.067）是影响Stanford A型AD术后AKI行CRRT患者预后的独立危险因素。早期CRRT组患者3个月内死亡率低于晚期CRRT组患者，但差异无统计学意义（P=0.624）。结论：年龄及血肌酐是影响Stanford A型AD术后AKI行CRRT患者预后的独立危险因素。是否早期行CRRT对患者3个月内预后无影响。

英文摘要:

Abstract Objective: To analyze the risk factors of death and the relationship between the timing of continuous renal replacement therapy (CRRT) and prognosis in patients with acute renal injury(AKI) after Stanford type A aortic dissection surgery (AD). Methods: Totally, 39 patients with Stanford type A AD complicated with AKI were selected retrospectively, including 18 patients in survival group and 21 patients in death group. The perioperative parameters and risk factors of death were analyzed. The effect of early (within 48h after operation) and late (after 48h after operation) CRRT on survival rate was analyzed. Results: There were no significant differences in age, sex, body mass index (BMI), relevant medical history, blood routine, serum creatinine, cardiac ultrasound, data of cardiopulmonary bypass, blood loss during operation, transfusion of red blood cell suspension, hemostasis after twice thoracotomy and use of vasoactive drugs between the two groups (P>0.05). Age (HR=1.115, P=0.01,95% CI: 1.046-1.189) and serum creatinine (HR=1.013, P=0.035,95% CI: 1.006-1.067) were independent risk factors for the outcome of patients with Stanford type A postoperative AKI undergoing CRRT. The 3-month mortality rate in early CRRT group was lower than that in late CRRT group, but the difference was not significant (P=0.624). Conclusion: Age and creatinine are independent risk factors for the prognosis of patients undergoing CRRT with postoperative AKI of Stanford type A. Whether or not to do CRRT early had no effect on the prognosis of patients within 3 months.