中国血液净化

中国血液净化 ›› 2025, Vol. 24 ›› Issue (05): 375-381.doi: 10.3969/j.issn.1671-4091.2025.05.004

• 临床研究 • 上一篇    

A型主动脉夹层患者手术后行连续性肾脏替代治疗危险因素的Meta分析

李 晓    曹瑞杨    王 勇    张瑞芳   

  1. 266000 青岛，1康复大学青岛市市立医院急诊科
    276002 临沂，2临沂市人民医院心脏大血管外科
  • 收稿日期:2024-09-23 修回日期:2025-01-29 出版日期:2025-05-12 发布日期:2025-05-12
  • 通讯作者: 张瑞芳 E-mail:zrflhz007@163.com
  • 基金资助:
    山东省中医药科技项目(M-2023215)

Meta-analysis of risk factors for continuous renal replacement therapy in patients after type A aortic dissection surgery

LI Xiao， CAO Rui-yang， WANG Yong， ZHANG Rui-fang   

  1. Department of Emergency, Qingdao Municipal Hospital, Rehabilitation University, Qingdao 266000, China; 2Department of Cardiac Macrovascular Surgery, Linyi People's Hospital, Linyi 276002, China
  • Received:2024-09-23 Revised:2025-01-29 Online:2025-05-12 Published:2025-05-12
  • Contact: 266000 青岛，1康复大学青岛市市立医院急诊科 E-mail:zrflhz007@163.com

摘要： 目的 系统评价A型主动脉夹层患者手术后需行连续性肾脏替代治疗(continuous renal replacement treatment，CRRT)的危险因素。 方法 检索维普、万方医学、中国知网、中国生物医学文献、中国医学期刊全文、Web of Science、PubMed、Embase、Cochrane library等数据库中A型主动脉夹层患者手术后需行CRRT危险因素的研究，采用RevMan 5.4软件对相关危险因素进行Meta分析。 结果 共纳入13项病例对照研究，6145例患者。Meta分析结果显示：年龄(MD=1.90,95% CI：0.50～3.31，P＜0.01)、慢性肾脏病病史(OR=4.11,95% CI：2.54～6.65，P＜0.01)、肝功能不全(OR=2.05,95% CI：1.52～2.78，P＜0.01)、手术前心包压塞(OR=2.48,95% CI：1.16～5.31，P=0.02)、手术前心包积液(OR=3.20,95% CI：1.23～8.31)，P=0.02)、夹层累及肾动脉(OR=2.42，95% CI：1.28～4.60，P＜0.01)、左心室舒张末期内径(MD=-1.23,95% CI：-2.21～-0.25，P=0.01)、血小板(MD=-14.28,95% CI：-26.35～-2.21，P=0.02)、白细胞(MD=1.02,95% CI：0.44～1.61，P＜0.01)、尿素氮(MD=0.85,95% CI：0.71～1.00，P＜0.01)、白蛋白(MD=-1.12,95% CI：-2.07～-0.18，P=0.02)、肌红蛋白(MD=79.64,95% CI：48.02～105.87，P＜0.01)、血肌酐(MD=41.59,95% CI：27.43～55.75，P＜0.01)、冠状动脉搭桥(OR=2.60,95% CI：1.40～4.82，P＜0.01)、手术时间(MD=50.66,95% CI：37.59～63.72，P＜0.01)、转机时间(MD=32.08,95% CI：22.89～41.27，P＜0.01)、主动脉阻断时间(MD=15.31,95% CI：11.63～18.99，P＜0.01)、体外循环时间(MD=27.70,95% CI：13.81～41.58，P＜0.01)、手术中出血量(MD=128.03,95% CI：22.52～233.55，P=0.02)、输血小板量(MD=0.78,95% CI：0.17～1.39，P=0.01)、输血浆量(MD=176.53,95% CI：6.78～346.29，P＜0.01)、输红细胞量(MD=3.26,95% CI：1.63～4.89，P＜0.01)、辅助通气时间(MD=73.77,95% CI：19.44～128.09，P＜0.01)、住ICU时间(MD=3.81,95% CI：0.84～6.77，P＜0.01)、二次开胸(OR=4.27,95% CI：2.75～6.63，P＜0.01)与A型主动脉夹层手术后需行CRRT有关。 结论 本研究A型主动脉夹层患者手术后行CRRT的危险因素囊括一般因素、既往病史、手术前状况、手术前血液检查、同期手术操作、手术中情况、手术后情况等多个方面，建议临床工作者有针对性的进行危险因素筛查，早期识别危险因素，适时开展CRRT，改善患者的临床预后结局。

关键词: 主动脉夹层, 连续性肾脏替代治疗, 危险因素

Abstract: Objective To systematically evaluate the risk factors for postoperative continuous renal replacement therapy (CRRT) in patients with type A aortic dissection. Methods  Studies investigating risk factors for CRRT after surgery in patients with type A aortic dissection were retrieved from databases including VIP, Wanfang Medical, China National Knowledge Infrastructure, China Biomedical Literature, China Medical Journal, Web of Science, PubMed, Embase, and Cochrane Library. Meta-analysis of relevant risk factors was performed using RevMan 5.4 software.  Results  A total of 13 case-control studies involving 6,145 patients were included. Meta-analysis revealed the following risk factors significantly associated with postoperative CRRT: age (MD = 1.90, 95% CI:0.50～3.31,P<0.01),history of chronic kidney disease (OR=4.11,95% CI:2.54～6.65,P<0.01), hepatic dysfunction (OR=2.05, 95% CI:1.52～2.78,P <0.01), preoperative cardiac tamponade (OR=2.48, 95% CI:1.16～5.31,P=0.02), preoperative pericardial effusion (OR =3.20, 95% CI:1.23～8.31,P =0.02), renal artery involvement by dissection (OR =2.42, 95% CI:1.28～4.60,P<0.01), left ventricular end-diastolic diameter (MD=-1.23, 95% CI:-2.21～-0.25,P=0.01),platelet count (MD=-14.28,95% CI:-26.35～-2.21,P=0.02), White blood cell count (MD=1.02,95% CI: 0.44～1.61,P <0.01), blood urea nitrogen (MD=0.85, 95% CI:0.71～1.00,P<0.01), albumin (MD=-1.12, 95% CI:-2.07～-0.18,P=0.02),myoglobin (MD=79.64,95% CI:48.02～105.87,P<0.01), serum creatinine (MD=41.59, 95% CI:27.43～55.75,P<0.01), coronary artery bypass grafting (OR=2.60, 95% CI:1.40～4.82,P<0.01), operative duration (MD=50.66, 95% CI:37.59～63.72,P<0.01), cardiopulmonary bypass time (MD=32.08, 95% CI:22.89～41.27,P<0.01), aortic cross-clamp time (MD=15.31, 95% CI:11.63～18.99,P<0.01), extracorporeal circulation time (MD=27.70, 95% CI:13.81～41.58,P<0.01), intraoperative blood loss (MD =128.03, 95% CI:22.52～233.55,P=0.02), platelet transfusion volume (MD=0.78, 95% CI:0.17～1.39, P=0.01),plasma transfusion volume (MD=176.53, 95% CI:6.78～346.29, P<0.01),red blood cell transfusion volume (MD=3.26, 95% CI:1.63～4.89, P<0.01), mechanical ventilation duration (MD=73.77, 95% CI:19.44～128.09, P<0.01), ICU stay duration (MD=3.81, 95% CI:0.84～6.77, P<0.01), re-exploration for bleeding (OR=4.27, 95% CI:2.75～6.63, P<0.01).  Conclusion  Risk factors for postoperative CRRT in patients with type A aortic dissection encompass multiple aspects, including general factors, medical history, preoperative status, preoperative laboratory tests, concurrent surgical procedures, intraoperative variables, and postoperative conditions. Clinicians should conduct targeted risk factor screening, identify high-risk patients early, and initiate CRRT appropriately to improve clinical prognosis.

Key words: Aortic dissection, Continuous renal replacement treatment, Risk factors

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