摘要
目的探讨肺移植术后早期急性肾损伤(AKI)的发生率、危险因素及预后。方法回顾性分析2017年4月至2019年6月在中日友好医院接受肺移植的167例受者的临床资料,根据改善全球肾脏病预后组织(KDIGO)指南标准诊断肺移植术后7 d内是否发生AKI,计算AKI的发生率,分析其相关危险因素,并探讨其对患者短期及长期预后的影响。结果肺移植术后早期AKI发病率为65.9%(110/167)。其中AKI 1期25.7%(43/167),AKI 2期21.6%(36/167),AKI 3期18.6%(31/167)。性别(男性)、术前血清肌酐(sCr)基础值高和肾小球滤过率(eGFR)基础值低、术前应用有创机械通气(MV)或体外膜肺氧合(ECMO)、术中或术后出现严重低血压、心血管事件以及术后并发感染性休克、多脏器功能衰竭、体外膜肺氧合(ECMO)支持≥2 d、再次插管等均是肺移植术后早期发生AKI的危险因素(P<0.05)。预后分析结果显示,肺移植术后早期并发AKI受者的术后MV时间、ECMO支持时间以及重症监护室(ICU)滞留时间较未发生AKI受者明显延长,肺移植术后短期及长期死亡率显著增高(P<0.05)。结论肺移植术后早期AKI发生率高,明显影响受者预后。应重视高危受者的早期预防,以降低其AKI发生率,改善其预后。
Objective To explore the incidence,risk factors and outcome of acute kidney injury(AKI)early after lung transplantation(LT).Methods Clinical data were retrospectively reviewed for 167 LT patients.AKI was defined according to the criteria of Kidney Disease Improving Global Outcomes(KDIGO)guideline within the first 7 days post-LT.AKI incidence was calculated.Multivariate analysis was performed to identify independent risk factors.Survival analysis was presented with the Kaplan-Meier curve.Results The incidence of AKI early post-LT was 65.9%.Gender(male),preoperative higher serum creatinine(sCr),lower glomerular filtration rate(eGFR),extracorporeal membrane oxygenation(ECMO),mechanical ventilation(MV),intraoperative or postoperative hypotension,cardiovascular events,postoperative septic shock,multiple organ failure,ECMO support≥2 days and reintubation were risk factors for AKI early post-LT(P<0.05).Postoperative AKI was correlated with prolonged MV and/or ECMO as well as ICU stay and higher short/long-term mortality post-LT.Conclusions The incidence of AKI early post-LT is high and affects the prognosis of LT patients.Greater attention should be paid to early prevention of AKI to reduce its incidence and improve its prognosis.
作者
荆蕾
赵丽
郭丽娟
梁朝阳
陈静瑜
Jing Lei;Zhao Li;Guo Lijuan;Liang Chaoyang;Chen Jingyu(Department of Lung Transplantation,Respiratory Diseases Center,China-Japan Friendship Hospital,National Clinical Research Center of Respiratory Diseases,Beijing 100029,China;Lung Transplant Center,Affiliated Municipal People's Hospital,Nanjing Medical University,Wuxi 214043,China)
出处
《中华器官移植杂志》
CAS
2021年第10期599-603,共5页
Chinese Journal of Organ Transplantation
基金
中国医学科学院中央级公益性科研院所基本科研业务费专项资金(2019PT320020)。
关键词
肺移植
急性肾损伤
危险因素
Lung transplantation
Acute kidney injury
Risk factors
作者简介
通信作者:陈静瑜,Email:chenjy@wuxiph.com。
