心脏手术相关急性肾损伤患者的远期预后

发布时间：2018-03-23 04:11

本文选题：急性肾损伤　切入点：心脏手术　出处：《肾脏病与透析肾移植杂志》2017年04期 　论文类型：期刊论文

【摘要】：目的:观察心脏手术相关急性肾损伤(CSA-AKI)患者的远期存活情况及肾脏转归。方法:本研究纳入2012年1月至2013年12月在南京医科大学第一附属医院住院行心脏手术治疗的患者,按是否发生CSA-AKI分为AKI组与非AKI组,平均随访3年,记录远期生存率及慢性肾脏病(CKD)3期及以上的发病率,并分析其相关影响因素。结果:共纳入1 363例心脏手术患者,CSA-AKI发病率为33.5%。AKI组3年累计生存率低于非AKI组(88.8%vs 97.2%,P0.001);与非AKI组比,AKI显著增加患者的死亡风险(HR 2.62,95%CI 1.53~4.50);多因素COX回归分析显示,AKI是增加死亡风险的独立危险因素;90d存活的AKI组术后3年CKD 3~5期的发病率高于非AKI组(9.9%vs 2.3%,P0.001);与非AKI组比,AKI组发生CKD 3~5期的风险增加(HR 3.10,95%CI1.75~5.48);多因素COX回归分析显示,AKI是增加远期CKD 3~5期风险的独立危险因素,高龄、术前估算的肾小球滤过率(e GFR)低也会增加远期CKD 3~5期风险。结论:CSA-AKI显著增加患者术后3年的死亡风险和CKD 3~5期发病率。需重视CSA-AKI的防治,并加强肾功能的长期随访,以改善患者的远期预后。
[Abstract]:Objective: to observe the long-term survival and renal outcome of patients with acute renal injury associated with cardiac surgery. Methods: this study included patients hospitalized in the first affiliated Hospital of Nanjing Medical University from January 2012 to December 2013. According to the occurrence of CSA-AKI, the patients were divided into AKI group and non-#en2# group. The long-term survival rate and the incidence of chronic kidney disease were recorded. Results: the incidence of CSA-AKI in 1 363 patients undergoing cardiac surgery was lower than that in non-#en1# group. The 3-year cumulative survival rate in 33.5%.AKI group was lower than that in non-#en1# group (P 0.001), and the risk of death in 33.5%.AKI group was significantly higher than that in AKI group (HR 2.62 卤95CI 1.534.50). COX regression analysis showed that the incidence of stage 35 of CKD in the AKI group with 90 days survival was higher than that in the non-#en3# group (P 0.001), and the risk of CKD stage 35 in the AKI group was higher than that in the non-#en4# group, and the risk of CKD stage 35 in the AKI group was higher than that in the non-#en4# group. The risk of CKD stage 35 in the AKI group was higher than that in the non-#en4# group, and the risk of CKD stage 35 in the AKI group was higher than that in the non-#en3# group. The risk of CKD stage 35 in the AKI group was higher than that in the control group. The regression analysis showed that Aki was an independent risk factor to increase the risk of stage 3 / 5 of CKD. In old age, low glomerular filtration rate (GFR) estimated before operation will also increase the long-term risk of CKD stage 3 to 5. Conclusion the death risk and stage 5 incidence of CKD 3 years after operation are significantly increased in patients with CSA-AKI. It is necessary to pay attention to the prevention and treatment of CSA-AKI and to strengthen the long-term follow-up of renal function. To improve the long-term prognosis of patients.
【作者单位】：南京医科大学第一附属医院肾内科;南京医科大学第一附属医院胸心外科;嘉兴学院附属第一医院肾内科;
【基金】：江苏省青年自然科学基金(BK20151022) 江苏省临床医学科技专项(BL2014080)
【分类号】：R654.2;R692.5

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