文章摘要
吴路加,童 光,罗 林,马 涛,王晓武,张卫达.全弓置换术后并发急性肾功能损伤患者住院死亡危险因素分析[J].南京医科大学学报,2018,(4):500~504
全弓置换术后并发急性肾功能损伤患者住院死亡危险因素分析
Risk factors of hospital death in patients with acute kidney injury after total arch replacement
投稿时间:2017-09-14  
DOI:10.7655/NYDXBNS20180415
中文关键词: 全弓置换  肾功能损伤  住院死亡  危险因素
英文关键词: total arch replacement  acute kidney injury  hospital death  risk factors
基金项目:国家自然科学基金青年基金(81500183,81500298);总后勤部临床高新技术重大专项(2010gxjs031);广东省自然科学基金(2014A030310473)
作者单位
吴路加 广州军区广州总医院心脏外科广东 广州 510010南方医科大学研究生院广东 广州 510515 
童 光 广州军区广州总医院心脏外科广东 广州 510010 
罗 林 广州军区广州总医院心脏外科广东 广州 510010 
马 涛 广州军区广州总医院心脏外科广东 广州 510010 
王晓武 广州军区广州总医院心脏外科广东 广州 510010 
张卫达 广州军区广州总医院心脏外科广东 广州 510010南方医科大学研究生院广东 广州 510515 
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中文摘要:
      目的:分析全弓置换术后并发急性肾功能损伤(acute kidney injury,AKI)患者的住院期间死亡危险因素,为患者住院期间治疗提供参考。方法:回顾性分析2007年3月—2017年3月广州军区广州总医院行全弓置换的258例患者中术后并发AKI的123例患者,其中术后住院期间死亡23例,将其纳入死亡组,余100例患者均顺利出院,纳入存活组,分析其术前、术中、术后资料,将单因素分析有意义结果纳入多因素COX回归分析,将患者根据AKI分级行Kaplan?Meier曲线分析。结果:生存患者平均住院时间为37.89 d,多因素分析结果得术前肌酐(HR=1.013)、糖尿病(HR=4.291)、二次开胸(HR=4.412)、术后低氧血症(HR=5.634)为全弓置换术后AKI患者死亡的独立危险因素,差异有统计学意义。Kaplan?Meier曲线分析得AKI 3级患者相较于AKI 1级病死率明显升高(P < 0.05)。结论:术前肌酐、糖尿病、二次开胸、术后低氧血症为全弓置换并发AKI患者术后死亡的独立危险因素,且AKI 3级患者死亡风险更高。
英文摘要:
      Objective:To analyze risk factors of hospital death in patients with postoperative acute kidney injury(AKI)after total arch replacement and to provide a reference for the treatment of patients during hospitalization. Methods:We retrospectively analyzed 123 patients whom underwent total arch replacement and had postoperative AKI in the Guangzhou Military Hospital from March 2007 to March 2017. Among them,23 patients died during hospitalization and were included in the death group,and the remaining 100 patients were discharged smoothly and were included in the survival group. Preoperative,intraoperative and postoperative data were analyzed. After univariate analysis,the risk factors were analyzed by COX regression analysis. According to the AKI classification,the survival rate was analyzed by Kaplan?Meier curves. Results:The average length of hospital stay was 37.89 days. The COX regression analysis showed that preoperative creatinine(HR value:1.013),diabetes mellitus(HR value:4.291),re?operation for bleeding(HR value:4.412),postoperative hypoxemia(HR value:5.634)were independent risk factors of hospital death in patients with postoperative AKI after total arch replacement,the difference was statistically significant. Kaplan?Meier curve showed that AKI 3 patients had a significant increase in mortality in comparing with AKI 1 patients(P < 0.05). Conclusion:Preoperative creatinine,diabetes mellitus,re?operation for bleeding,and postoperative hypoxemia are independent risk factors for hospital death in patients with AKI after total arch replacement,and the risk of death is higher in AKI 3 patients.
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