心肺转流时间与开放性胸主动脉手术后急性肾损伤风险的关系OA

Objective To investigate the relationship between prolonged cardiopulmonary bypass(CPB)time and the risk of acute kidney injury(AKI)after open thoracic aortic surgery.Methods A retrospective analysis was conducted on 114 patients who underwent open thoracic aortic surgery in our hospital from January 1,2021 to December 31,2024,including 53 patients with acute aortic syndrome(AAS).The primary endpoint was the incidence of postoperative AKI.According to the guidelines for improving global prognosis of chronic kidney disease,AKI was further divided into stages Ⅰ,Ⅱ,and Ⅲ.The secondary endpoint was the mortality rate within 30 days after surgery.Results Fiftysix patients(49.12％)developed AKI after surgery,including 30 cases of AKI stage Ⅰ,15 cases of AKI stage Ⅱ,and 11 cases of AKI stage Ⅲ.The proportion of patients without AKI complicated with AAS was lower than that of the AKI group,especially in AKI stage Ⅲ(P<0.05).In addition,AKI stage Ⅲ patients had the highest ICU stay,highest reoperation rate,and highest early mortality rate(all P<0.05).After adjusting for covariates and confounding factors using a multiple logistic regression model,there was an independent correlation between CPB time and AKI risk(OR=1.062-1.169,P<0.05).The receiver operating characteristic(ROC)curve showed that the predic-tion of postoperative AKI by CPB time had good discrimination[area under the curve:0.736(95％CI:0.640-0.833)],and the deviation between the predicted probability and the actual probability of CPB time was not statistically significant(Hosmer-Le-meshow test:P=0.890).Decision curve analysis showed that within the high-risk threshold range,the nomogram model has good clinical application value.Multivariate logistic regression forest plot showed that CPB time remained an independent influencing factor for postoperative AKI in AAS patients[OR(95％CI):1.031(1.003-1.059),P=0.031]and non-AAS patients[OR(95％CI):1.033(1.008-1.059),P=0.010].In addition,long surgical time[OR(95％CI):1.500(1.364-1.976),P=0.025]and long CPB time[OR(95％CI):1.086(1.054-1.318),P=0.007]were also independent risk factors for early postoperative mortality in patients.Conclusion An increase in CPB time is associated with an increased risk of AKI after open thoracic aortic surgery,regardless of whether the patient have AAS.Prolonged surgery time and CPB time are independent risk factors for postoperative AKI.