主动脉夹层术后急性肾损伤需行连续性肾脏替代治疗患者肾功能影响因素分析OA
Analysis of factors influencing renal function in patients with acute kidney injury requiring continuous renal replacement therapy after aortic dissection surgery
目的 探讨主动脉夹层术后需要连续性肾脏替代治疗(CRRT)的严重急性肾损伤(AKI)患者短期肾功能转归的影响因素.方法 回顾性分析2019年1月至2022年12月在首都医科大学附属北京安贞医院心外科主动脉夹层术后发生急性肾损伤,需行CRRT治疗患者51例,随访3个月,收集基线临床资料及随访资料,采用logistic回归分析影响患者肾功能的危险因素.结果 最终纳入有完整随访资料的患者51例,其中31例(60.8％)患者在3个月的临床随访期间肾功能完全恢复或部分恢复,脱离血液透析治疗.与需要维持性血液透析患者相比,脱离血液透析患者术后CRRT期间低血压持续时间较短[154(121,198)min比163(120,200)min],术中体外循环持续时间较短[198(171,234)min 比 202(192,250)min],左室射血分数(LVEF)较高[60.0(56.0,65.0)比 58.0(50.8,61.5)].多因素 logistic回归分析显示,影响术后AKI需CRRT治疗患者肾功能恢复的因素是CRRT期间低血压持续时间(OR=0.867,95％CI 0.761～0.987,P=0.031)、左室射血分数(OR 1.102,95％CI 1.002～1.231,P=0.041).结论 术后 CRRT 期间低血压持续时间和术后LVEF是主动脉夹层术后接受CRRT的AKI患者肾功能恢复的独立影响因素.
Objective To investigate the risk factors affecting shortterm renal outcome in patients with severe acute kidney injury(AKI)requiring continuous renal replacement therapy(CRRT)after aortic dissection surgery.Methods A retrospective analysis was conducted on 51 patients who developed AKI after aortic dissection surgery and required CRRT at the department of cardiac surgery,Beijing Anzhen Hospital,Capital Medical University,between January 2019 and December 2022.Patients were followed up for 3 months.Baseline clinical data and followup data were collected,and logistic regression analysis was used to identify risk factors affecting renal prognosis.Results A total of 51 patients with complete followup data were finally included,of whom 31(60.8％)achieved complete or partial renal recovery and were weaned from hemodialysis during the 3month clinical followup period.Compared with patients requiring maintenance hemodialysis,those weaned from hemodialysis had a shorter duration of hypotension during the postoperative CRRT period[154(121,198)min vs.163(120,200)min],shorter cardiopulmonary bypass time[198(171,234)min vs.202(192,250)min],and higher left ventricular ejection fraction[60.0(56.0,65.0)vs.58.0(50.8,61.5)].Logistic regression analysis showed that the independent factors for renal recovery in patients with postoperative AKI requiring CRRT was the duration of hypotension during CRRT[OR 0.867,95％CI(0.761-0.987),P=0.031],left ventricular ejection fraction[OR=1.102,95％CI(1.002-1.231),P=0.041].Conclusion The duration of hypotension during postoperative CRRT and postoperative left ventricular ejection fraction are independent factors influencing renal recovery in patients with AKI receiving CRRT after aortic dissection surgery.
杨敏;陈岚;陈文梅;卞维静;王国勤
首都医科大学附属北京安贞医院肾内科,北京 100029首都医科大学附属北京安贞医院肾内科,北京 100029首都医科大学附属北京安贞医院肾内科,北京 100029首都医科大学附属北京安贞医院肾内科,北京 100029首都医科大学附属北京安贞医院肾内科,北京 100029
医药卫生
急性肾损伤主动脉夹层连续性肾脏替代治疗左室射血分数
acute renal injuryaortic dissectioncon-tinuous renal replacement therapyleft ventricular ejection fraction
《中国实用内科杂志》 2026 (4)
322-327,343,7
北京市属医院科研培育计划(PX2022024)
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