体外循环下心脏瓣膜术后急性肾损伤的危险因素分析

发布时间：2018-07-01 21:41

  本文选题：心脏瓣膜手术 + 体外循环　； 参考：《浙江大学》2017年硕士论文

【摘要】：目的:回顾性分析成人体外循环下心脏瓣膜手术后急性肾损伤(acute kidney injury,AKI)的发病率及危险因素并初步建立中国心脏瓣膜手术后急性肾损伤的预测模型。方法:回顾性分析2010年1月-2015年12月1349例体外循环下心脏瓣膜手术患者的临床资料,根据2012年KIDGO指南的临床诊断标准,将其分为AKI组和非AKI组。统计术后AKI的发生情况,并进行单因素和多因素回归分析心脏瓣膜术后AKI的发生率和危险因素。建立国人心脏瓣膜术后AKI预测模型;通过分辨力(受试者工作曲线下面积,AUROC)、校准度(Hosmer-lemeshow拟合优度检验)验证模型的预测价值。结果:1349例心脏瓣膜手术患者中有383例发生AKI,发生率为28.4%,多因素Logistic 回归分析显示,年龄(OR,1.05;P0.001)、糖尿病史(OR,2.11;P=0.008)、术前贫血(OR,1.50;P=0.026)、术前肌酐水平(OR,1.01;P=0.001)、手术时间(OR,1.28;P0.001)、术中输注血浆(OR,1.50;P=0.004)是心脏瓣膜术后发生AKI的独立危险因素,ROC曲线下面积是0.729,提示根据危险因素建立的模型的分辨力和校准度均较好。结论:体外循环下心脏瓣膜术后AKI的独立危险因素是高龄、糖尿病史、术前贫血、术前肌酐高、手术时间长以及术中输注血浆。
[Abstract]:Objective: to retrospectively analyze the incidence and risk factors of acute renal injury (acute kidney injuryaki) after cardiac valve surgery in adults under cardiopulmonary bypass (CPB) and to establish a predictive model of acute renal injury after cardiac valve surgery in China. Methods: the clinical data of 1349 patients undergoing cardiac valve surgery under cardiopulmonary bypass from January 2010 to December 2015 were retrospectively analyzed and divided into AKI group and non-AKI group according to the clinical diagnostic criteria of KIDGO guidelines in 2012. The incidence and risk factors of AKI after cardiac valve operation were analyzed by univariate and multivariate regression analysis. The prediction model of AKI after cardiac valve surgery in Chinese was established, and the predictive value of the model was verified by resolution (area under the operating curve) and Hosmer-lemeshow goodness of fit test. Results 383 of 1349 patients with heart valve surgery had AKI, the incidence rate was 28.4.The multivariate logistic regression analysis showed that, Age (OR1. 05 / P0.001), history of diabetes (OR2. 11 / P0. 008), preoperative anemia (OR1. 50 / P0. 026), preoperative creatinine level (OR1. 01 / P0. 001), time of operation (OR1. 28 / P0. 001), intraoperative infusion of plasma (OR1. 50 P0. 004) were independent risk factors for AKI after heart valve surgery. The area under the ROC curve was 0. 729, suggesting that the model based on risk factors was established. The resolution and calibration are good. Conclusion: the independent risk factors for AKI after cardiac valve surgery under cardiopulmonary bypass are old age, history of diabetes, preoperative anemia, high preoperative creatinine, long operation time and intraoperative infusion of plasma.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R654.2
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本文编号：2089242