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目的评价心脏手术患者术前心功能对术后并发急性肾损伤(AKI)的影响。方法回顾性分析2004年1月1日—2007年6月30日在上海交通大学医学院附属仁济医院行心脏手术的所有住院患者的资料,采用AKI网络(AKIN)推荐的AKI定义统计心脏手术后AKI的发生率,对患者术前的心功能进行评估,并分析其他可能造成术后AKI的危险因素。结果1056例患者中,术后发生AKI328例,发生率为31.1%。AKI组的院内病死率为11.6%(38/328),显著高于非AKI组的0.7%(5/728,P<0.01)。多因素Logistic回归分析显示,在校正年龄、术前高尿酸血症、冠状动脉旁路移植联合瓣膜手术、手术时间、术后循环血容量不足等因素后,术前左心功能不全仍是心脏手术后发生AKI的独立危险因素(OR=2.53,95%CI为1.24～5.13,P=0.01)。结论术前左心功能不全是心脏手术后发生AKI的独立危险因素。
Objective To evaluate the effect of preoperative cardiac function on acute postoperative acute kidney injury (AKI) in patients undergoing cardiac surgery. Methods The data of all inpatients who underwent cardiac surgery at Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine from January 1, 2004 to June 30, 2007 were retrospectively analyzed. AKI AKI-defined statistical cardiac surgery Post-AKI rates were used to assess preoperative cardiac function and to analyze other risk factors that may contribute to postoperative AKI. Results Among 1056 patients, 328 cases of AKI occurred after operation, the incidence was 31.1%. In-hospital mortality was 11.6% (38/328) in the AKI group, significantly higher than 0.7% (5/728, P <0.01) in the non-AKI group. Multivariate logistic regression analysis showed that preoperative left ventricular dysfunction was still a heart surgery after correction of age, preoperative hyperuricemia, coronary artery bypass grafting combined with valve surgery, operation time, postoperative blood volume deficits and other factors There was an independent risk factor for AKI (OR = 2.53, 95% CI 1.24-5.13, P = 0.01). Conclusion Preoperative left ventricular dysfunction is an independent risk factor for AKI after cardiac surgery.