论文部分内容阅读
目的探讨急性A型主动脉夹层术后急性肾衰竭(acute renal failure,ARF)的危险因素。方法回顾性分析2002年1月至2013年3月间接受手术的266例急性A型主动脉夹层患者资料,根据患者术后是否发生ARF分为ARF组和无ARF组,比较两组间一般临床特征间的差异,并采用多因素条件logistic回归方法分析术后ARF的独立危险因素。结果18例(6.77%)患者术后发生ARF。两组患者在术前心功能不全(NYHAⅢ~Ⅳ级,P=0.024)、肾功能不全(P=0.002)、术中体外循环时间≥190min(P=0.000)、主动脉阻断时间≥90min(P=0.015)及术后二次开胸止血(P=0.004)、脑损伤(P=0.013)和急性呼吸功能障碍(P=0.000)的人数分布差异有统计学意义。ARF组患者的体外循环时间、主动脉阻断时间和围术期红细胞输注量高于无ARF组,差异有统计学意义(P均<0.05)。多因素条件logistic回归分析显示术前肾功能不全(OR=6.978,95%CI为1.874~25.997)、体外循环时间≥190min(OR=5.663,95%CI为1.621~19.781)、围术期大量输注红细胞(OR=1.071,95%CI为1.030~1.113)和术后急性呼吸功能障碍(OR=4.853,95%CI为1.467~16.053)是术后ARF发生的独立危险因素。结论 ARF是多种因素共同作用导致的严重并发症。术后早期应严密观察患者病情变化,及时进行ARF评估并个体化干预,以减少住院死亡率并改善预后。
Objective To investigate the risk factors of acute renal failure (ARF) after acute type A aortic dissection. Methods The data of 266 patients with acute type A aortic dissection who underwent surgery between January 2002 and March 2013 were retrospectively analyzed. According to whether ARF was divided into ARF group and no ARF group after operation, The differences between the two groups were analyzed using multivariate conditional logistic regression to analyze the independent risk factors of postoperative ARF. Results ARF occurred in 18 patients (6.77%) after operation. Preoperative cardiac insufficiency (NYHAⅢ ~ Ⅳ, P = 0.024), renal insufficiency (P = 0.002), cardiopulmonary bypass time ≥190min (P = 0.000), aortic cross-clamping time≥90min P = 0.015), postoperative thoracotomy (P = 0.004), brain injury (P = 0.013) and acute respiratory dysfunction (P = 0.000). The time of cardiopulmonary bypass, the time of aortic block and perioperative erythrocyte transfusion in patients with ARF were significantly higher than those without ARF (P <0.05). Multivariate conditional logistic regression analysis showed that preoperative renal insufficiency (OR = 6.978, 95% CI 1.874 to 25.997), cardiopulmonary bypass time ≥190min (OR = 5.663, 95% CI 1.621-19.781) Erythrocytes (OR = 1.071, 95% CI 1.030 ~ 1.113) and postoperative acute respiratory dysfunction (OR = 4.853, 95% CI 1.467 ~ 16.053) were independent risk factors for postoperative ARF. Conclusion ARF is a serious complication caused by many factors. Patients should be closely observed in the early postoperative changes in condition, timely ARF assessment and individualized intervention to reduce hospital mortality and improve prognosis.