先天性心脏病小儿术后急性肾损伤的临床危险因素分析

发布时间：2018-05-31 05:19

本文选题：先天性心脏病 + 急性肾损伤　；参考：《第三军医大学学报》2017年09期

【摘要】：目的探讨4岁先天性心脏病小儿术后发生急性肾损伤(acute kidney injury,AKI)的临床危险因素。方法收集2015年4月至2016年4月在新桥医院行先天性心脏病手术治疗的4岁患儿临床资料,以改良儿童肾脏疾病风险分级(pediatric risk injury failure loss and end stage kidney diseases,pRIFLE)作为AKI诊断标准,分析术后AKI发生率,比较术后发生AKI(AKI组)与未发生AKI(N-AKI组)患儿的差异,并利用多因素Logistic回归分析筛选小儿先天性心脏病术后发生AKI的临床危险因素。结果共纳入298例患儿,其中男性152例,女性146例。107例(35.91%)患儿术后发生AKI,其中危险期82例(27.52%),损伤期16例(5.37%),衰竭期9例(3.02%)。与N-AKI组相比,AKI组患儿平均年龄、身高、体质量更低,术前合并紫绀及其他重要疾病概率更高,血清肌酐(serum creatinine,Scr)更低,ASA分级更高;手术时间、体外循环(cardiac pulmonary bypass,CPB)时间、主动脉钳闭时间(aortic clamping time,ACT)更长;术后尿素、尿酸、Scr、胱抑素、视黄醇结合蛋白更高,肌酐清除率(estimated creatinine clearance,eCCl)更低,住院时间更长,死亡率更高。其中年龄1岁、术前合并紫绀、术前Scr低、手术时间较长是术后发生AKI的独立危险因素。结论年龄1岁、术前合并紫绀、术前Scr低、手术时间较长会显著增加小儿先天性心脏病术后AKI发生风险。
[Abstract]:Objective to investigate the clinical risk factors of acute kidney injury (AKI) in children with congenital heart disease after 4 years of age. Methods the clinical data of 4 year old children with congenital heart disease in Xinqiao Hospital from April 2015 to April 2016 were collected to improve the risk classification of children's kidney disease (pediatric risk injury failure loss). And end stage kidney diseases, pRIFLE) as a diagnostic criterion for AKI, the incidence of postoperative AKI was analyzed, and the difference between the postoperative AKI (AKI group) and the non AKI (N-AKI) children was compared. The clinical risk factors of children with congenital heart disease were screened by multiple factor regression analysis. The results were included in 298 cases, male, male and female. 152 cases of sex, 146 cases of.107 (35.91%) in women, 82 cases (27.52%), 16 cases of injury (5.37%), 9 cases (3.02%) in the failure period. Compared with group N-AKI, the average age, height, and body mass of the AKI group were lower. Before operation, cyanosis and his important disease were higher, serum creatinine (serum creatinine, Scr) was lower, ASA classification was lower. Higher operation time, cardiac pulmonary bypass, CPB time, aortic clamping time (aortic clamping time, ACT) longer; postoperative urea, uric acid, Scr, cystatin, retinol binding protein, creatinine clearance (estimated creatinine clearance) lower, longer hospitalization time, and higher mortality. The age was 1 years old. Anterior combined cyanosis, low preoperative Scr and longer operation time are independent risk factors for AKI after operation. Conclusion age 1 years old, cyanosis before operation, low preoperative Scr and longer operation time will significantly increase the risk of AKI in children with congenital heart disease.
【作者单位】：第三军医大学新桥医院麻醉科;
【分类号】：R726.5;R726.9

【相似文献】