股股转流辅助下开放性胸腹主动脉瘤修复术后急性肾损伤危险因素分析:单中心回顾性研究OA

Objective To investigate the incidence,staging,and perioperative risk factors of acute kidney injury(AKI)after open thoracoabdominal aortic aneurysm(TAAA)repair assisted by femoro-femoral bypass(FFB).Methods We retro-spectively enrolled 294 consecutive patients who underwent open TAAA repair with FFB assistance at Beijing Anzhen Hospital between January 2018 and December 2024.AKI was defined and staged according to the Kidney Disease:Improving Global Outcomes(KDIGO)criteria.Perioperative characteristics were compared between patients with and without AKI.Univariate and multivariable logistic regression analyses were performed with three outcomes:any-stage AKI,moderate-to-severe AKI(KDIGO stages 2-3),and postoperative need for continuous renal replacement therapy(CRRT).Odds ratios(ORs)with 95%confidence intervals(CIs)were reported.Results Postoperative AKI occurred in 59.5%(175/294)of patients;KDIGO stages 1,2,and 3 accounted for 28.9%(85/294),14.3%(42/294),and 16.3%(48/294),respectively.Moderate-to-severe AKI(stages 2-3)occurred in 30.6%(90/294),and 11.9%(35/294)required CRRT.Compared with the non-AKI group,patients with AKI were older and had longer cardiopulmonary bypass time,longer visceral/renal artery clamping time,higher blood loss and red blood cell(RBC)transfusion volume,lower intraoperative urine output,and higher peak lactate levels(all P<0.05).In the multivariable model for any-stage AKI,older age(OR=1.04,95%CI 1.01-1.08;P=0.011),higher intraoperative peak lactate(OR=1.27,95%CI 1.09-1.47;P=0.003),and greater intraoperative RBC transfusion(OR=1.09,95%CI 1.01-1.18;P=0.030)were independently asso-ciated with AKI,whereas higher intraoperative urine output was protective.In the model for moderate-to-severe AKI,older age(OR=1.05,95%CI 1.02-1.08;P=0.004),intraoperative RBC transfusion(per 1 unit:OR=1.14,95%CI 1.06-1.23;P<0.001),and higher peak lactate(OR=1.15,95%CI 1.01-1.32;P=0.042)were independent risk factors.In the CRRT model,older age(OR=1.08,95%CI 1.03-1.13;P=0.001)and higher peak lactate(OR=1.32,95%CI 1.14-1.54;P<0.001)were independently associated with postoperative CRRT requirement.Conclusions AKI was common after FFB-assisted open TAAA repair.Ad-vanced age and elevated intraoperative lactate were independently associated with the risk of AKI and CRRT,while transfusion requirement indicated an increased risk of moderate-to-severe AKI.Perioperative management should focus on optimizing distal perfusion and oxygen delivery with dynamic lactate monitoring and timely correction of hypoperfusion,alongside refined hemo-stasis and blood management to reduce transfusion exposure,thereby lowering the risk of severe AKI and CRRT.