摘要
目的探讨孙氏手术治疗的Stanford A型主动脉夹层(TAAD)患者术后发生3期急性肾损伤(AKI)的危险因素。方法单中心、回顾性研究。连续收集2020年1月至2022年6月于天津市胸科医院心外科行孙氏手术治疗的224例TAAD患者的临床资料,其中男性167例(74.6%)。以患者入院时血肌酐水平为基线值,根据改善全球肾脏病预后组织(KDIGO)共识的AKI诊断和分期标准,将患者术后分为3期AKI组和非3期AKI组。通过单因素和多因素logistic回归分析筛选出孙氏手术治疗的TAAD患者术后发生3期AKI的独立危险因素,并依据危险因素建立预测模型。采用受试者工作特征(ROC)曲线下面积(AUC)判断模型对孙氏手术治疗的TAAD患者术后发生3期AKI的预测价值。结果224例TAAD患者术后有34例发生3期AKI,发生率为15.2%。与非3期AKI组比较,3期AKI组患者的基线资料中夹层累及肾动脉比例、中性粒细胞/淋巴细胞比值、血肌酐水平较高和总蛋白水平较低,术中体外循环时间、主动脉阻断时间和手术时间较长、输血量较大、使用重组人凝血因子Ⅶ比例较高和术后血小板计数较低,差异均有统计学意义(均为P<0.05)。多因素logistic回归分析结果显示,夹层累及肾动脉(OR=2.734,95%CI:1.102~6.786,P=0.032)、术前血肌酐水平(OR=1.019,95%CI:1.008~1.030,P=0.001)、术中输血量(OR=1.114,95%CI:1.008~1.288,P=0.037)和术后血小板计数(OR=0.980,95%CI:0.964~0.996,P=0.017)是TAAD患者经孙氏手术治疗后发生3期AKI的独立影响因素。应用多因素分析结果建立预测模型,绘制ROC曲线,结果显示该模型对孙氏手术治疗的TAAD患者术后发生3期AKI的预测准确性为84.3%(AUC=0.843,95%CI:0.774~0.913)。结论夹层累及肾动脉、术前血肌酐水平高、术中输血量大和术后血小板计数低的TAAD患者行孙氏手术治疗后更容易发生3期AKI。
Objective To explore the risk factors of stage 3 acute kidney injury(AKI)in patients with Stanford type A aortic dissection(TAAD)after Sun s procedure.Methods This was a single-center,retrospective study.Clinical data of 224 patients(167 males)with TAAD who underwent Sun s procedure at the Department of Cardiac Surgery of Tianjin Chest Hospital from January 2020 to June 2022 were retrospectively collected.According to the AKI diagnosis and staging criteria based on the consensus of Kidney Disease:Improving Global Outcomes(KDIGO),the patients were divided into stage 3 AKI group and non-stage 3 AKI group after Sun s procedure.Univariate and multivariate logistic regression analysis were used to detect the independent risk factors for the occurrence of stage 3 AKI after surgery for TAAD patients,and a prediction model was established based on these risk factors.The area under the receiver operating characteristic(ROC)curve(AUC)was used to determine the predictive value of the model for the occurrence of stage 3 AKI after Sun s procedure for TAAD patients.Results There were 34 TAAD patients developed stage 3 AKI after Sun s procedure,with an incidence rate of 15.2%(34/224).Compared with the non-stage 3 AKI group,the data in stage 3 AKI group showed a higher proportion of aortic dissection involving the renal arteries,a higher neutrophil-to-lymphocyte ratio,higher baseline serum creatinine levels,and lower total protein levels;intraoperative and postoperative data indicated longer cardiopulmonary bypass time,aortic cross-clamping time,and surgery duration,greater blood transfusion volume,a higher proportion of recombinant human coagulation factorⅦusage,and lower postoperative platelet counts(all P<0.05).The results of multivariate analysis revealed that involvement of renal artery in the dissection(OR=2.734,95%CI:1.102-6.786,P=0.032),preoperative serum creatinine level(OR=1.019,95%CI:1.008-1.030,P=0.001),intraoperative blood transfusion volume(OR=1.114,95%CI:1.008-1.288,P=0.037),and postoperative platelet count(OR=0.980,95%CI:0.964-0.996,P=0.017)were independent risk factors for the occurrence of stage 3 AKI after Sun s procedure for TAAD patients.By leveraging the results of multivariate analysis,a prediction model was established,and the ROC curve was plotted.The results showed that the model had a predictive accuracy of 84.3%(AUC=0.843,95%CI:0.774-0.913)for the occurrence of stage 3 AKI after Sun s procedure for TAAD patients.Conclusions Involvement of renal artery in the dissection,high preoperative serum creatinine level,large intraoperative blood transfusion volume,and low postoperative platelet count are associated with stage 3 AKI after Sun s procedure in TAAD patients.
作者
白耀邦
吴振华
齐玉娟
焦妍
姜楠
Bai Yaobang;Wu Zhenhua;Qi Yujuan;Jiao Yan;Jiang Nan(Intensive Care Unit,Department of Cardiac Surgery,Tianjin Chest Hospital,Tianjin 300222,China;Department of Cardiac Surgery,Tianjin Chest Hospital,Tianjin 300222,China)
出处
《中国心血管杂志》
北大核心
2025年第1期63-68,共6页
Chinese Journal of Cardiovascular Medicine
作者简介
通信作者:姜楠,电子信箱:jiangnantjxk@163.com。
