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目的分析心脏手术后发生急性肾功能衰竭(ARF)的危险因素。方法选择1994至2002年间心脏手术后发生ARF的患者108例,同期未发生ARF的患者152例为对照组。结果ARF组术前肌酐清除率(CCr)和左室射血分数都显著低于对照组(P＜0．01),体外循环时间、心脏停跳时间、手术总时间显著长于对照组(P＜0．01,P＜0．05,P＜0．01),术中输血量显著多于对照组(P＜0．01)。逐步Logistic回归分析提示术前NYHA心功能分级、基础CCr、术后低血压、术后再次开胸和心脏手术时间可预示心脏术后是否发生ARF,OR分别为3．04、0．97、9．66、11．61、1．32。结论术前心力衰竭、基础CCr降低、术后低血压、再次开胸术及手术时间延长是心脏术后发生ARF的重要危险因素。
Objective To analyze the risk factors of acute renal failure (ARF) after cardiac surgery. Methods A total of 108 patients with ARF after cardiac surgery between 1994 and 2002 were selected. 152 patients without ARF during the same period were selected as the control group. Results The preoperative creatinine clearance rate (CCr) and left ventricular ejection fraction in ARF group were significantly lower than those in control group (P <0.01). The time of cardiopulmonary bypass, cardiac arrest and total operation time in ARF group were significantly longer than those in control group (P < 0.01, P <0.05, P <0.01), blood transfusion volume was significantly more than the control group (P <0.01). Stepwise Logistic regression analysis showed that preoperative NYHA cardiac function classification, basal CCr, postoperative hypotension, postoperative thoracotomy and cardiac surgery time could predict ARF after cardiac surgery, OR were 3.04,0.97,9 .66,11.61,1.32. Conclusions Preoperative heart failure, reduction of basic CCr, postoperative hypotension, reoperation and prolonged operation time are important risk factors of ARF after cardiac surgery.