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目的 :应用KDIGO标准,评估心脏手术相关性急性肾损伤(cardiac surgery-associated acute kidney injury,CSA-AKI)的发病率及其相关危险因素。方法:回顾性分析南京医科大学附属南京医院2009年1月—2011年12月在体外循环(cardiopulmonary bypass,CPB)下进行心脏手术的1 575例患者的临床特征。采用单因素和多因素logistic回归分析CSA-AKI发生的影响因素。多元Cox比例风险模型评估CSA-AKI对ICU期间病死率和住院期间病死率的影响。结果:1 575例患者中,534例(34%)发生CSA-AKI,22例(1.4%)患者需要肾替代治疗,住院总病死率为1.3%(20/1 575)。CSA-AKI的独立危险因素为机械通气时间(P<0.001)、CPB时间≥100 min(P<0.01)、输注红细胞(P<0.001)、术后3 d内体温超过38℃(P<0.05)等,而使用乌司他丁与CSA-AKI低发生率相关(P<0.01)。Cox比例风险模型结果显示AKI住院期间死亡风险是非AKI患者的2.26倍(P<0.05),而需要肾脏替代治疗患者其死亡风险是非肾脏替代患者的18.65倍(P<0.001)。结论:CSA-AKI的发生与机械通气时间、输注红细胞以及术后3 d内体温超过38°C等密切相关。乌司他丁的使用与CSA-AKI低发病率有关。CSA-AKI与住院期间死亡风险显著相关,尤其是接受肾替代治疗的患者。
Objective: To evaluate the incidence and related risk factors of cardiac surgery-associated acute kidney injury (CSA-AKI) using KDIGO standard. Methods: The clinical features of 1 575 patients undergoing cardiac surgery under cardiopulmonary bypass (CPB) from January 2009 to December 2011 at Nanjing Hospital Affiliated to Nanjing Medical University were retrospectively analyzed. Univariate and multivariate logistic regression analysis of CSA-AKI influencing factors. Multivariate Cox proportional hazards model was used to assess the effect of CSA-AKI on case-fatality rates during hospitalization and on-patient mortality during hospitalization. RESULTS: Of the 575 patients, 534 (34%) developed CSA-AKI and 22 (1.4%) required renal replacement therapy with a total hospital mortality of 1.3% (20/1 575). The independent risk factors of CSA-AKI were mechanical ventilation time (P <0.001), CPB time≥100 min (P <0.01), erythrocyte transfusion (P <0.001), body temperature over 38 ℃ ), While the use of ulinastatin was associated with a lower incidence of CSA-AKI (P <0.01). Cox proportional hazards model results showed that the risk of death during AKI hospitalization was 2.26 times higher than that of non-AKI patients (P <0.05), while those requiring renal replacement therapy were 18.65 times more likely to die than non-renal replacement patients (P <0.001). Conclusions: The occurrence of CSA-AKI is closely related to the time of mechanical ventilation, the transfusion of erythrocytes, and body temperature over 38 ° C within 3 days after operation. Ulinastatin is associated with a low incidence of CSA-AKI. CSA-AKI was significantly associated with the risk of death during hospitalization, especially in patients undergoing renal replacement therapy.