文章摘要
心肺转流下心脏瓣膜术后急性肾损伤的危险因素分析
Risk factors for perioperative acute kidney injury in adult cardiac valve surgery with cardiopulmonary bypass
  
DOI：
中文关键词: 心脏瓣膜手术  心肺转流  急性肾损伤  危险因素
英文关键词: Cardiac valve surgery  Cardiopulmonary bypass  Acute kidney injury  Risk factors
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作者单位E-mail
傅之梅 310009,杭州市,浙江大学医学院附属第二医院麻醉科,现在浙江省立同德医院麻醉科  
严敏 310009,杭州市,浙江大学医学院附属第二医院麻醉科 zryanmin@zju.edu.cn 
郁丽娜 310009,杭州市,浙江大学医学院附属第二医院麻醉科  
张冯江 310009,杭州市,浙江大学医学院附属第二医院麻醉科  
周振锋 310009,杭州市,浙江大学医学院附属第二医院麻醉科  
孙凯 310009,杭州市,浙江大学医学院附属第二医院麻醉科  
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中文摘要:
      目的 探讨成人心肺转流(cardiopulmonary bypass， CPB)下心脏瓣膜手术后急性肾损伤(acute kidney injury， AKI)的危险因素。方法 回顾性分析1 349例心脏瓣膜手术患者的临床资料，采用多因素Logistic回归分析心脏瓣膜术后AKI的危险因素。结果 1 349例心脏瓣膜手术患者AKI发生率为28.4％，多因素Logistic回归分析显示，每增加1岁(OR=1.05，95%CI 1.03～1.06，P<0.001)、糖尿病史(OR=2.11，95%CI 1.22～3.68，P=0.008)、贫血(OR=1.50，95%CI 1.05～2.21，P=0.026)、术前血清肌酐(Scr)值每增加1 mg/dl(OR=1.01，95%CI 1.01～1.02，P=0.001)、手术时间每增加1 h(OR=1.28，95%CI 1.15～1.41，P<0.001)、术中输注血浆(OR=1.50，95%CI 1.14～1.97，P=0.004)是心脏瓣膜术后发生AKI的独立危险因素。结论 心肺转流下心脏瓣膜术后急性肾损伤的独立危险因素是高龄、糖尿病史、贫血、术前肌酐高、手术时间长以及术中输注血浆。
英文摘要:
      Objective To investigate the risk factors of acute kidney injury (AKI) in patients undergoing cardiac valve surgery with cardiopulmonary bypass (CPB). Methods A retrospective cohort database study was conducted, involving 1 349 patients undergoing heart valve surgery with CPB technique. Logistic regression was used to screen out the risk factors of AKI after the surgery. Results Of the 1 349 patients, the incidence of AKI in valve surgery was 28.4%. One year older (OR=1.05, 95%CI 1.03-1.06, P<0.001), diabetes (OR=2.11, 95%CI 1.22-3.68, P=0.008), anemia (OR=1.50, 95%CI 1.05-2.21, P=0.026), each additional basic serum creatinine of 1 mg/dl (OR=1.01, 95%CI 1.01-1.02, P=0.001), each additional operation time of 1 hour (OR=1.28, 95%CI 1.15-1.41, P<0.001), plasma transfusion during surgery (OR=1.50, 95%CI 1.14-1.97, P=0.004) were the independent risk factors for AKI in multivariate logistic regression model. Conclusion AKI is a common and serious complication following cardiac valve surgery. More attention should be paid to the patients with elder age, anemia, prolonged operation time, diabetes, increased basic serum creatinine and requirement of plasma transfusion during surgery.
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