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Stanford A型主动脉夹层深低温停循环术后急性肾功能衰竭相关因素分析

Analysis of factors related to acute renal failure post deep hypothermia circulatory arrest surgery of type a aorta dissection surgery

摘要:

目的 分析Stanford A型主动脉夹层患者深低温停循环(DHCA)手术后发生急性肾功能衰竭(ARF)的危险因素,探讨与住院死亡率的关系.方法 回顾性研究2011年9月至2013年5月273例经DHCA下手术的Stanford A型主动脉夹层患者的临床资料,根据术后是否发生ARF分为:非ARF组(163例)及AFR组(110例).记录患者性别、年龄、相关病史、心功能、术前及术后血清肌酐值、DHCA时间、出血及输血量、术后并发症等临床资料,对术后发生ARF及死亡的相关危险因素进行单因素及多因素Logistic回归分析.结果 住院死亡16例(5.9%),非ARF组死亡3例(1.8%),ARF组死亡13例(11.8%).ARF组110例(40.3%)患者中接受连续性肾脏替代治疗(CRRT)的21例(7.7%).单因素分析:男性(x2=6.075,P=0.014)、术前血清肌酐值(t=2.955,P =0.004)、夹层累及肾动脉(x2 =5.103,P =0.024)、体外循环(CPB)时间(t=2.435,P =0.017)、DHCA时间(t=2.215,P=0.031)、CPB期间下肢平均动脉压(t=-2.832,P=0.007)、术中及术后24 h 出血量(t=2.157,P=0.034)及输血量(t=2.426,P=0.018)、术后急性呼吸功能不全(x2=36.307,P=0.000)、术后二次气管插管(x2 =9.167,P=0.002)、术后低血压(x2=10.202,P=0.001)、术后暂时性神经系统损伤(x2 =7.512,P=0.006)、术后感染(x2=11.088,P=0.001)是Stanford A型主动脉夹层手术后ARF发生的相关危险因素.多因素回归分析:术前血清肌酐值(P =0.023)、术后急性呼吸功能不全(P=0.011)是Stanford A型主动脉夹层手术后ARF发生的独立危险因素;术后急性肾功能衰竭(P=0.022)、CRRT(P=0.003)、术后永久性神经功能损伤(P =0.034)是住院死亡的独立危险因素.结论 Stanford A型主动脉夹层手术后发生ARF较为常见,是多因素导致的并发症,是手术死亡的危险因素,应重视围术期肾功能保护.

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abstracts:

Objectives To analyze risk factors associated to acute renal failure (ARF) post deep hypothermia circulatory arrest (DHCA) surgery of type A aorta dissection patients,researching correlations to hospital mortality rate.Methods There were 273 samples of type A aorta dissection patients collected between September 2011 and May 2013,all of which had surgery done under DHCA.Categorize the samples into two groups based on whether postoperative ARF happened:non-ARF group(n =163) and ARF group (n =110).Conducted regression analysis correlations between postoperative ARF and mortality and one or more risk factors of gender,age,history of illness,type of aorta dissection,heart functional class,pre-and post-operative serum creatinine (sCr),DHCA time,blood loss and blood transfusion volume,postoperative complications,etc.Results Among the 110 samples of ARF group (40.3%),21 (7.7%) conducted continuous renal replacement therapy (CRRT).Among 16 (5.9%) died in hospital,3 (1.8%) died with functional renal,13 (11.8%) died with ARF.Single factor analysis:male (x2 =6.075,P =0.014),preoperative sCr (t =2.955,P =0.004),dissection extended to renal artery(x2 =5.103,P =0.024),cardiopulmonary by-pass (CBP) time (t =2.435,P =0.017),DHCA time (t =2.215,P =0.031),average lower limb artery blood pressure during CBP (t =-2.832,P =0.007),during surgery and 24 h postoperative blood loss (t =2.157,P =0.034) and blood transfusion (t =2.426,P =0.018),postoperative acute respiratory dysfunction (x2 =36.307,P =0.000),postoperative endotraeheal reintubation (x2 =9.167,P =0.002),postoperative low blood pressure (x2 =10.202,P =0.001),postoperative temporary neurological deficits (x2 =7.512,P =0.006),postoperative infection (x2 =1 1.088,P =0.001) were the risk factors for ARF.The logistic regression analysis revealed that preoperative sCr (P =0.023) and acute respiratory dysfunction (P =0.011) were independent determinants of ARF; preoperative ARF (P =0.022),CRRT (P =0.003) and permanent neurological deficits were independent determinants for hospital mortality.Conclusions ARF is a common complication of post Type A aorta dissection surgery under DHCA,and is the risk factor of hospital mortality.It is important to enhance peri-operative protection of the renal function.

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