摘要
目的探讨冠状动脉造影术到心脏瓣膜手术时间间隔对术后急性肾损伤(AKI)发生的影响。方法回顾性收集2017年1月至2018年12月在南京医科大学第一附属医院住院行冠脉造影和心脏瓣膜手术患者的术前基线资料、手术相关资料以及临床预后资料。采用倾向性评分匹配、单因素和多因素Logistic回归分析,探讨冠脉造影到手术时间间隔对瓣膜手术术后发生急性肾损伤的影响。结果共纳入符合标准的患者338例,其中女性患者164例。术后AKI发病率为25.4%(86/338)。根据冠脉造影到心脏瓣膜手术时间间隔中位数6 d,将所有患者分为≤6 d组(206例)和>6 d组(132例)。两组患者在术前基线指标、术中相关指标以及在AKI发生率方面差异均无统计学意义。单因素回归分析显示,年龄、基线肌酐、估算的肾小球滤过率、手术时间、体外循环时间、主动脉阻隔时间、停跳时间均为瓣膜手术后AKI的相关危险因素。时间间隔6 d与心脏术后AKI发生无明显相关性。多因素Logistic回归分析显示时间间隔6 d与术后AKI的发生无显著相关性。结论冠状动脉造影术到心脏瓣膜手术时间间隔可能不是术后发生AKI的独立危险因素。
Objective To investigate the impact of the time interval from coronary angiography to valvular surgery on the occurrence of postoperative acute kidney injury(AKI).Methods Preoperative baseline data,surgical data,and clinical prognosis data of patients,who were admitted to the First Affiliated Hospital of Nanjing Medical University from January 2017 to December 2018 and underwent both coronary angiography and cardiac valve surgery,were collected retrospectively.Propensity score matching,univariate and multivariate logistic regression methods were used to investigate the impact of the time interval from coronary angiography to valvular surgery on the occurrence of postoperative AKI.Results A total of 338 patients were enrolled in the study,among whom there were 164 female patients.The incidence of postoperative AKI was 25.4%(86/338).According to the median time interval of 6 days,all the patients were divided into two groups:≤6 d group(206 cases)and>6 d group(132 cases).There were no significant differences between the two groups in preoperative baseline indicators,intraoperative related indicators,and the incidence of AKI.Univariate regression analysis showed that age,baseline creatinine,estimated glomerular filtration rate,operation time,extracorporeal circulation time,aortic cross-clamp time,and cardiac arrest time were all the related risk factors for AKI after valve surgery,but there was no significant correlation between the 6-day interval and the occurrence of AKI after cardiac valve surgery.And the multivariate logistic regression analysis also showed that there was no significant correlation between the 6-day interval and the occurrence of postoperative AKI.Conclusion The time interval between coronary angiography and valvular surgery may not be an independent risk factor for the postoperative AKI.
作者
李美媛
刘康
邬步云
俞香宝
朱亚梅
毛慧娟
邢昌赢
Li Meiyuan;Liu Kang;Wu Buyun;Yu Xiangbao;Zhu Yamei;Mao Huijuan;Xing Changying(Department of Nephrology, First Affiliated Hospital of Nanjing Medical University (Jiangsu Provincial People′s Hospital), Nanjing 210029, Jiangsu Province, China)
出处
《中华肾病研究电子杂志》
2021年第3期126-132,共7页
Chinese Journal of Kidney Disease Investigation（Electronic Edition）
基金
国家自然基金面上项目(81970639)
2017年江苏省卫生和健康委员会科研项目(H2017023)。
