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目的:观察肺动脉收缩压（PASP）与体外循环（CPB）心脏手术患者术后发生急性肾损伤（AKI）及预后的关系。方法:检索医院信息系统（HIS）和麦迪斯顿麻醉临床信息系统（DoCare），回顾性分析2015年1月1日至2016年12月31日在北京安贞医院行CPB心脏手术的9 860例患者的临床资料。根据术后是否发生AKI分为两组，收集患者的一般资料、手术类型，术前合并症、射血分数、血肌酐（SCr）、PASP，术中CPB时间、主动脉阻断时间、液体平衡情况、血制品和药物使用情况，术后机械通气时间、重症监护病房（ICU）住院时间和住院时间以及围手术期中心静脉压（CVP）等临床资料。采用多因素Logistic回归分析筛选患者术后发生AKI的危险因素。根据术前PASP水平分为≥60 mmHg（1 mmHg＝0.133 kPa）组和<60 mmHg组，比较两组患者术后AKI的发生情况及预后。所有患者出院后均进行电话随访，并根据随访结果分为存活组和死亡组，比较两组患者的临床资料，采用多因素Cox回归分析筛选患者远期死亡的危险因素。采用Kaplan-Meier生存曲线分析不同术前PASP水平两组患者远期预后。结果:共6 285例患者纳入最终分析。① 6 285例患者中术后发生AKI 2 592例（41.2%），其中改善全球肾脏病预后组织（KDIGO）1期1 697例（65.5%），为主要AKI类型。单因素分析显示，年龄，术前射血分数、SCr、PASP及合并冠心病、高血压、糖尿病，术中CPB时间、主动脉阻断时间、液体平衡量、红细胞输入量和去甲肾上腺素、多巴胺、肾上腺素用量，术后机械通气时间、ICU住院时间、住院时间以及围手术期CVP可能是患者术后发生AKI的危险因素。多因素Logistic回归分析显示，术前PASP是CPB心脏手术患者术后发生AKI的独立危险因素之一〔优势比（n OR）＝4.753，95%可信区间（95%n CI）为1.328～8.417，n P＝0.004〕。PASP≥60 mmHg组术后AKI发生率明显高于<60 mmHg组〔73.8%（712/965）比35.3%（1 880/5 320），n P<0.01〕。② 6 285例患者随访时间（11±3）个月，死亡237例（3.8%），PASP≥60 mmHg组患者病死率明显高于<60 mmHg组〔9.5%（92/965）比2.7%（145/5 320），n P<0.01〕；Kaplan-Meier生存曲线分析显示，两组累积存活率差异有统计学意义（Log-Rank检验：n χ2＝144.400，n P<0.001）。单因素分析显示，男性、年龄，术前合并高血压、射血分数、PASP，术中CPB时间、主动脉阻断时间、液体平衡量、肾上腺素用量，术后机械通气时间、ICU住院时间、住院时间以及围手术期CVP可能是CPB心脏手术患者远期死亡的危险因素；多因素Cox回归分析显示，术前PASP每增加1 mmHg，患者远期病死率增加1.126倍〔风险比（n HR）＝1.126，95%n CI为1.003～1.604，n P＝0.021〕。n 结论:术前PASP升高与CPB心脏术后发生AKI有关，也是此类患者远期死亡的独立危险因素。“,”Objective:To observe the relationship between pulmonary artery systolic pressure (PASP) and acute renal injury (AKI) and prognosis after cardiopulmonary bypass (CPB) heart surgery.Methods:The clinical data of 9 860 patients who underwent CPB heart surgery in Beijing Anzhen Hospital from January 1st, 2015 to December 31st, 2016 were analyzed retrospectively. The patients were divided into two groups according to whether AKI occurred after operation. The clinical data were obtained from hospital information system (HIS) and DoCare including general information, types of operation, preoperative complication, ejection fraction, serum creatinine (SCr), PASP, intraoperative CPB duration, aortic occlusion duration, fluid balance, blood products and drug usage, postoperative mechanical ventilation duration, length of intensive care unit (ICU) and hospital stay, and perioperative central venous pressure (CVP). Multivariate Logistic regression analysis was used to screen the risk factors of AKI after operation. According to the preoperative PASP level, the patients were divided into ≥ 60 mmHg (1 mmHg = 0.133 kPa) group and < 60 mmHg group, and the incidence of AKI and prognosis after operation were compared between the two groups. All patients were followed up by telephone after discharge, and they were divided into survival group and death group according to the follow-up results, and the clinical data were compared between the two groups. Multivariate Cox regression analysis was used to screen the risk factors of long-term prognosis. Kaplan-Meier survival curve was used to analyze the long-term prognosis of two groups with different preoperative PASP levels.Results:6 285 patients were enrolled in the final analysis. ① Among the 6 285 patients, 2 592 patients (41.2%) suffered from AKI after operation, of whom 1 697 (65.5%) were stage 1 according to Kidney Disease: Improving Global Outcomes (KDIGO), which was the main type of AKI. Univariate analysis showed that age, preoperative ejection fraction, SCr, PASP, coronary heart disease, hypertension, diabetes, intraoperative CPB duration, aortic occlusion duration, fluid balance, red blood cell input and norepinephrine, dopamine, epinephrine dosage, postoperative mechanical ventilation duration, the length of ICU and hospital stay, and perioperative CVP might be the risk factors of AKI after operation. Multivariate Logistic regression analysis showed that preoperative PASP was one of independent risk factors for AKI in patients undergoing CPB heart surgery [odds ratio (n OR) = 4.753, 95% confidence interval (95%n CI) was 1.328-8.417, n P = 0.004]. The incidence of AKI after operation in PASP ≥ 60 mmHg group was significantly higher than that in < 60 mmHg group [73.8% (712/965) vs. 35.3% (1 880/5 320), n P < 0.01]. ② After a follow-up of (11±3) months, 237 patients (3.8%) died in 6 285 patients. The mortality of patients in PASP ≥ 60 mmHg group was significantly higher than that in < 60 mmHg group [9.5% (92/965) vs. 2.7% (145/5 320), n P < 0.01]. Kaplan-Meier survival curve analysis showed that there was a significant difference between the two groups in cumulative survival rate (Log-Rank test: n χ2 = 144.400, n P < 0.001). Univariate analysis showed that male, age, preoperative hypertension, ejection fraction, PASP, intraoperative CPB duration, aortic occlusion duration, fluid balance, epinephrine dosage, postoperative mechanical ventilation duration, the length of ICU and hospital stay, and perioperative CVP might be risk factors for long-term death of patients undergoing CPB heart surgery. Multivariate Cox regression analysis showed that for every 1 mmHg increase in preoperative PASP, the long-term mortality increased by 1.126 times [hazard ratio ( n HR) = 1.126, 95%n CI was 1.003-1.604, n P = 0.021].n Conclusion:The increase of PASP is related to AKI after CPB heart surgery, which is an independent risk factor for long-term mortality.