目的 探讨A型主动脉夹层术后重度急性肾损伤(AKI)的危险因素及其诊断价值，分析不同肾脏替代治疗的透析策略对重度AKI的疗效。方法 回顾性收集该院2019年1月至2021年12月行A型主动脉夹层术后发生重度AKI的69例患者临床资料，分为重症组(滤过治疗，24例)和轻症组(未滤过治疗，45例)。比较两组临床资料，通过单因素及多因素logistic回归分析、受试者工作特征(ROC)曲线分析A型主动脉夹层术后发生重度AKI的危险因素及其诊断价值;比较术后治疗指标变化，分析不同透析策略疗效。结果 术后重度AKI发生率为34。78％。单因素及多因素logistic回归分析显示，术前血肌酐升高(OR=0。98，95％CI:0。97～0。99，P=0。02)、体外循环总时间延长(OR=0。99，95％CI:0。97～0。99，P=0。02)、术后 24 h 输血量增加(OR=0。99，95％CI:0。98～0。99，P＜0。01)是A型主动脉夹层术后发生重度AKI的独立危险因素。ROC曲线分析显示，体外循环总时间、术前血肌酐、术后24 h输血量联合对A型主动脉夹层术后发生重度AKI有较高的诊断价值，灵敏度、特异度及曲线下面积分别为91。10％、75。00％、0。90。早期行滤过及使用持续肾脏替代治疗(CRRT)对重度AKI有更好的疗效。结论 A型主动脉夹层术后发生重度AKI的独立危险因素包括术前血肌酐升高、术中体外循环总时间延长和术后24 h输血量增加，且三者联合对重度AKI有较高的诊断价值。早期发现并及时使用肾脏替代治疗能够改善重度AKI，CRRT较间歇性血液透析治疗(IHD)效果好。
Analysis of risk factors and dialysis strategies for severe acute kidney injury after type A aortic dissection operation
Objective To investigate the risk factors and diagnostic value of severe acute kidney injury(AKI)after type A aortic dissection,and to analyze the efficacy of different dialysis strategies of renal replace-ment therapy on severe AKI.Methods The clinical data of 69 patients with severe AKI after type A aortic dissection operation in this hospital from January 2019 to December 2021 were retrospectively collected.The patients were divided into the severe group(dialysis treatment,24 cases)and the mild group(without conduc-ting filtration treatment,45 cases).The clinical data were compared between the two groups,and the risk fac-tors and diagnostic value for the severe AKI occurrence after type A aortic dissection surgery by univariate and multivariate regression and receiver operating characteristic(ROC)curve.The changes of postoperative treat-ment indicators were compared and the efficacy of different dialysis strategies were analyzed.Results The in-cidence rate of severe AKI after surgery was 34.78％.The univariate and multivariate logistic regression ana-lyses results showed that preoperative serum creatinine increase(OR=0.98,95％CI:0.97-0.99,P=0.02),total extracorporeal circulation time prolongation(OR=0.99,95％CI:0.97-0.99,P=0.02)and postopera-tive 24 h blood transfusion volume increase(OR=0.99,95％CI:0.98-0.99,P＜0.01)were the independent risk factors for postoperative severe AKI occurrence in the patients with type A aortic dissection.The ROC curve analysis suggested that the combination of total time of extracorporeal circulation,preoperative serum creatinine value and postoperative 24 h blood transfusion volume had good diagnostic value for postoperative severe AKI occurrence in the patients with type A aortic dissection.The sensitivity,specificity and area under the curve were 91.10％,75.00％and 0.90 respectively.Early performing filtration and continuous renal re-placement therapy(CRRT)in the severe AKT had better effect.Conclusion The independent risk factors for postoperative severe AKI occurrence in type A aortic dissection include preoperative serum creatinine in-crease,intraoperative total extracorporeal circulation time prolongation and postoperative 24 h blood transfu-sion volume increase,and the three combination has good predictive value for severe AKI.Early detection and timely using renal replacement therapy could improve severe AKI,CRRT has a better effect for AKI than in-termitlent hemodialysis(IHD).
万方数据
维普
