中国血液净化

中国血液净化 ›› 2014, Vol. 13 ›› Issue (11): 763-766.doi: 10.3969/j.issn.1671-4091.2014.11.006

• 临床研究 • 上一篇    下一篇

血管外科手术后发生急性肾损伤的危险因素分析

王文姬1 ,孔炜颖1 ,李璞1 ,黄新天2 ,张薇1   

  1. 上海交通大学医学院附属第九人民医院1. 肾内科  2.血管外科
  • 收稿日期:2014-09-01 修回日期:2014-09-05 出版日期:2014-11-12 发布日期:2014-11-12
  • 通讯作者: 张薇 codein2004@126.com E-mail:dingfeng@fudan.edu.cn
  • 基金资助:

    上海市科委科研计划项目(编号：10411964300)；上海交通大学医学院附属第九人民医院院基金(编号2009B10)

The risk factors of acute kidney injury following vascular surgeries

  • Received:2014-09-01 Revised:2014-09-05 Online:2014-11-12 Published:2014-11-12

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摘要： 【摘要】目的探讨血管外科手术后急性肾损伤(acute kidney injury，AKI)发生的危险因素。方法回顾性分析2011 年血管外科住院患者的临床、手术及实验室检查资料，计算AKI 发病率和慢性肾脏病(chronic kidney disease，CKD)的患病率，并用Logistic 回归分析AKI 发生的危险因素。结果术后共发生AKI 为54 例(4.1%)，发生在主动脉夹层瘤16 例(26.2%)、急性肢体动脉栓塞10 例(17.5%)、动脉狭窄/栓塞15 例(3.3%)，发生AKI 的患者中死亡9 例(16.7%)。术前CKD 的实际患病率为17%(397 例)，而术前提供肾脏病史的仅有5.7%(133 例)。使用造影剂、CKD 病史、术中低血压、发生多脏器功能衰竭(multiple organ dysfunction syndrome，MODS)与术后AKI 的发生显著相关。Logistic 回归分析显示，合并上述四个危险因素患者发生AKI 的风险分别增加1.149、2.432、5.126 和6.645 倍(P＜0.05)。结论血管外科手术后AKI 的发生率较高，特别是主动脉夹层瘤和动脉栓塞疾病。既往有CKD 病史、术中低血压和发生MODS 是AKI 发生和患者死亡的主要危险因素。因此，需重视对CKD 的术前诊断和评估，并加强围手术期肾功能的观察和保护，及早发现和干预AKI的进展，有助于改善AKI 的预后。

关键词: 急性肾损伤, 血管外科手术, 危险因素

Abstract: Objective To evaluate the incidence of acute kidney injury and its risk factors after vascular surgery. Method The clinical, surgery and laboratory data of 1,332 patients undergoing vascular surgery in the year of 2011 were collected from electronic medical records and retrospectively reviewed. Result Fiftyfour (4.1%) of 1332 patients developed AKI after the surgery, including 16/61 aortic aneurysm, 10/57 acute limb arterial embolism, and 15/451 arterial stenosis/embolism. Nine of the 54 AKI patients (16.7%) died. The morbidity of chronic kidney disease (CKD) before the surgery was 17%. Logistic regression analysis revealed that radio-contrast media, a history of CKD, intraoperative hypotension and multiple organ dysfunction syndrome (MODS) were the risk factor of AKI (OR=1.149, 2.432, 5.126 and 6.645, respectively; P＜0.05). Conclusion Higher morbidity of AKI was found after vascular surgery, especially after aortic aneurysm and acute arterial embolism. A history of CKD, intraoperative hypotension and MODS were the major risk factors of AKI. Therefore, we should pay attention to the presence of CKD before surgery and changes of renal function after the surgery, to facilitate early diagnosis and appropriate treatment of AKI.

Key words: Acute kidney injury, Vascular surgery, Risk factor