Stanford A型主动脉夹层术后急性肾功能损伤危险因素分析及预后

doi:10.3969/j.issn.1005-6483.2020.05.020

摘要/Abstract

摘要： 目的:比较Stanford A型主动脉夹层术后发生急性肾功能损伤和未发生急性肾功能损伤两组病人的预后，分析发生急性肾功能损伤的高危因素。方法:2014年5月～2016年5月Stanford A型夹层术后发生急性肾功能损伤75例为病例组，按照年龄和体重1：1匹配75例肾功能正常病人作为对照组，分析发生急性肾功能损伤的高危因素，比较两组预后。结果:急性肾功能损伤组较未发生组早期并发症率增加1.9倍，肺部感染率增加1.7倍。随访3年，随访率97.0%，平均随访28个月。急性肾功能损伤组病人术后1个月、12个月、24个月及36个月免于远期并发症生存率明显低于未发生组（94.2%、91.2%、80.5%和26.4%比100%、98.6%、91.5%和77.8%，Logrank P<0.01）。围术期大剂量血管活性药（OR=3.455，95%CI：1.163～10.265）和静力型肾血管受损（OR=8.726，95%CI：2.149～35.426）是导致Stanford A型夹层术后发生急性肾功能损伤的高危因素。结论:Stanford A型主动脉夹层手术风险大，围术期大剂量血管活性药和静力型肾血管受损是术后并发急性肾功能损伤的独立高危因素，术后发生急性肾功能损伤病人预后相对较差，积极预防胜过治疗。

关键词: 主动脉夹层, 急性肾功能损伤, 预后, 高危因素

Abstract: Objective:To compare the prognosis of acute kidney injury and the absence of acute kidney injury with Stanford type A aortic dissection，and to analyze the high risk factors leading to acute kidney injury after surgery.Methods:From May 2014 to May 2016，75 patients with acute kidney injury after Stanford type A dissection were treated as a case group.Age and body weight were matched in 75 normal renal function groups as control group.The risk factors for acute kidney injury were analyzed.The prognosis of the two groups was compared.Results:The incidence of early complications of patients with acute kidney injury after Stanford type A aortic dissection increased about 1.9 times，and the rate of lung infection increased about 1.7 times compared with those who without.After 3 years of followup，the followup rate was 97.0% ，and the average followup was 28 months.The survival rate freedom from longterm complications decreased from 1 month，12 months，24 months，and 36 months after acute kidney injury compared with those who did not（94.2%，91.2%，80.5% and 26.4% vs.100%，98.6%，91.5% and 77.8%； Logrank P<0.01）.The perioperative highdose positiveinotropicdrugs（OR=3.455；95%CI：1.163～10.265）and static renal vascular damage（OR= 8.726；95%CI：2.149～35.426） were risk factors for acute kidney injury after Stanford type A dissection.Conclusion:Stanford type A aortic dissection surgery is dangerous，perioperative highdose positiveinotropicdrugs and static renal vascular damagewere risk factors for acute kidney injury after suregy.Those patients have a poor prognosis.Prevention is better than cure.

Key words: aortic dissection, acute kidney injury, prognosis, high risk factor

查正彪, 潘友民, 郑智等. Stanford A型主动脉夹层术后急性肾功能损伤危险因素分析及预后[J]. 临床外科杂志, 2020, 28(5): 467-470.

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