摘要
目的探讨<4岁的先天性心脏病患儿术后发生急性肾损伤的临床特点及相关因素。方法回顾性分析2017年1月至2018年12月于贵州省人民医院住院诊断为先天性心脏病并于体外循环下行心脏手术的<4岁患儿共410例临床资料,男201例,女209例,按术后是否发生急性肾损伤分为急性肾损伤组(n=42)和非急性肾损伤组(n=368)。收集并比较两组患儿性别、年龄、体重等人口学资料,术前、术中、术后临床资料,以及机械通气、总住院、ICU住院时长,住院花费及在院死亡情况。利用logistic回归分析筛选患儿术后发生急性肾损伤的因素。结果急性肾损伤组患儿年龄(17.9±11.6)个月,男25例;非急性肾损伤组患儿年龄(20.8±9.6)个月,男176例。两组年龄和性别比例差异均无统计学意义(均P>0.05)。与非急性肾损伤组患儿相比,急性肾损伤组患儿的体重更低[(8.2±3.3)kg比(9.9±2.6)kg,P=0.023];手术时间[(210.3±74.8)min比(149.1±52.2)min,P<0.001]、体外循环时间[(107.2±49.9)min比(60.2±29.2)min,P<0.001]、主动脉钳闭时间[62.0(50.0,88.0)min比34.5(18.3,52.3)min,P<0.001]更长;术后平均动脉压更低[(101.3±18.1)mmHg比(118.2±15.6)mmHg,P<0.001];机械通气时间、重症监护室时间、住院总时间更长,住院总花费更高,在院死亡发生率更高(均P<0.05)。多因素logistic回归分析结果显示,体重低(OR=0.489,95%CI:0.298~0.802,P=0.005)、术后平均动脉压低(OR=0.929,95%CI:0.891~0.969,P=0.001)、手术时间长(OR=1.035,95%CI:1.016~1.054,P<0.001)是先天性心脏病患儿心脏术后发生急性肾损伤的独立相关因素。结论体重低、术后平均动脉压低、手术时间长的先天性心脏病患儿术后发生急性肾损伤的风险更高。
Objective To investigate the clinical characteristics and risk factors of acute kidney injury(AKI)after pediatric congenital heart surgery among children aged<4 years old.Methods A total of 410 children<4 years old with congenital heart disease who underwent cardiac pulmonary bypass(CPB)surgery from Guizhou Provincial People′s Hospital between January 2017 and December 2018 were analyzed retrospectively.The patients were divided into two groups:AKI group(n=42)and non-AKI group(n=368)according to whether AKI occurred after surgery.The clinical data of patients was compared between two groups,including demographic data(sex,age,weight),preoperative,intraoperative and postoperative clinical data,the length of mechanical ventilation,hospitalization,intensive care unit(ICU)stay,hospital costs and death in hospital.Logistic regression analysis was used to screen the risk factors of postoperative AKI.Results Compared with non-AKI group,children in AKI group had lower weight[(8.2±3.3)kg vs(9.9±2.6)kg,P=0.023]and mean arterial pressure(MAP)[(101.3±18.1)mmHg vs(118.2±15.6)mmHg,P<0.001],but longer duration of surgery[(210.3±74.8)min vs(149.1±52.2)min,P<0.001],CPB[(107.2±49.9)min vs(60.2±29.2)min,P<0.001],aortic clamping[62.0(50.0,88.0)min vs 34.5(18.3,52.3)min,P<0.001],mechanical ventilation duration,ICU stay,hospital stay,and higher mortality.Multivariate logistic regression analysis showed that lower weight(OR=0.489,95%CI:0.298-0.802,P=0.005),lower MAP(OR=0.929,95%CI:0.891-0.969,P=0.001),longer duration of surgery(OR=1.035,95%CI:1.016-1.054,P<0.001)were the independent risk factors for AKI.Conclusion Children with lower weight,longer duration of surgery,lower MAP are at higher risk of getting AKI after congenital heart surgery.
作者
杨宇齐
袁立英
陈爽
崔梦笔
刘璐
查艳
Yang Yuqi;Yuan Liying;Chen Shuang;Cui Mengbi;Liu Lu;Zha Yan(Department of Nephrology,Guizhou Provincial People′s Hospital,Guiyang 550002,China;Department of Nephrology,the First People′s Hospital of Zunyi,Zunyi 563000,China)
出处
《中华医学杂志》
CAS
CSCD
北大核心
2019年第22期1717-1721,共5页
National Medical Journal of China
基金
贵州省高层次创新人才项目(黔科和平台人才[2018]5636号)
贵州省人民医院博士基金(GZSYBS[2017]07号).
关键词
先天性心脏病
儿童
急性肾损伤
Congenital heart disease
Children
Acute kidney injury
作者简介
通信作者:查艳,Email:zhayan72@126.com.
