245例心脏外科手术患者术后急性肾损伤的危险因素分析钟美容张丹凤[關键词]心脏外科手术;急性肾损伤;危险因素;输血[]R692[文献标识码]B[]1673-9701（2021）22-0035-06Riskfactorsanalysisofacutekidneyinjuryin245patientsundergoingcardiacsurgeryZHONGMeirong1ZHANGDanfeng21.DepartmentofNephrology，Fu激anMedicalUniversityUnionHospital，Fuzhou350001，China;2.DepartmentofAnesthesiology，Fu激anMedicalUniversityUnionHospital，Fuzhou350001，China[Abstract]ObjectiveToinvestigatetheincidencerateandriskfactorsofacutekidneyinjury（AKI）inpatientsundergoingcardiacsurgeryinFu激anMedicalUniversityUnionHospital.MethodsTheclinicaldataof245patientsundergoingcardiacsurgeryinFu激anMedicalUniversityUnionHospitalfromJanuarytoApril2020wereretrospectivelyanalyzed.UnivariateandmultivariateLogisticregressionanalysiswereusedtoscreentheriskfactorsofpostoperativeAKI.ResultsItwasfoundthattherewas90patients（36%）showingAKIamongthe245patients，andtheincidencerateofAKIstage1，AKIstage2andAKIstage3was20.4%，7.3%and9.0%respectively;19patients（7.8%）neededrenalreplacementtherapy.Theunivariateregressionanalysisresultindicatedthatthepreoperativeleftventricularejectionfraction（LVEF），thecardiopulmonarybypasstime，theemergencyoperation，theapplicationofcontrastmediuminperioperativeperiod，thebloodtransfusioninperioperativeperiod，thepreoperativecreatininelevel，preoperativewhitebloodcelllevelanddecreasedvalueofpostoperativehemoglobin，andthechangingvalueofpostoperativemeanplateletvolumewererelatedtoAKIaftercardiacsurgery.ThemultivariateLogisticregressionanalysisresultindicatedthebloodtransfusioninperioperativeperiod（OR=2.609，95%CI：1.203-5.699，P=0.015），thelongcardiopulmonarybypasstime（OR=1.395，95%CI：1.125-1.730，P=0.002），andthehighlevelofpreoperativecreatinine（OR=1.016，95%CI：1.002～1.031，P=0.024）wereindependentriskfactorsofpostoperativeAKI，andthehighpreoperativeleftventricularejectionfraction（LVEF）（OR=0.955，95%CI：0.924-0.987，P=0.004）wasaprotectivefactorofAKI.ConclusionPostoperativeAKIisoneofthecommoncomplicationsinpatientsundergoingcardiacsurgery.ImprovingperioperativecardiacandrenalfunctionandreducingtheneedforintraoperativebloodtransfusionarefeasiblemeasurestoreducetheincidencerateofAKIaftercardiacsurgery.[Keywords]Cardiacsurgery;Acutekidneyinjury;Riskfactors;Bloodtransfusion急性肾损伤是心脏外科手术后的主要并发症之一，由于研究人群及诊断标准的不同，心脏术后急性肾损伤的发病率各异，最高可达42%，仅次于脓毒血症，是导致重症监护室（Intensivecareunit，ICU）患者急性肾损伤的第二大病因[1]。心脏术后急性肾损伤（Acutekidneyinjury，AKI）往往伴随医疗负担加重，住院时间延长，死亡率升高，再住院率增加，住院期间死亡率升高及生活质量和长期生存率下降[2]。且心脏术后AKI发病机制复杂，目前仍不十分清楚，可能与围术期缺血再灌注损伤、炎症、氧化应激、溶血、肾毒性药物的使用、遗传易感性等多因素有关[3]。除了肾脏替代治疗作为严重的AKI患者支持性治疗手段，目前尚无有效的治疗方法，因此寻找可纠正的AKI危险因素对于预防AKI的发生、改善心脏手术患者的预后显得尤为重要。本研究旨在分析福建医科大学附属协和医院心脏外科手术患者术后AKI的发生率及其危险因素，为术后AKI的预防提供临床线索和依据，现报道如下。1资料与方法1.1一般资料纳入标准：选取2020年1—4月在福建医科大学附属协和医院接受心脏手术的患者。排除标准：①年龄1.2方法收集所有患者临床资料，包括人口学资料（年龄、性别等），合并其他疾病情况（糖尿病、高血压、冠心病、慢性肺部疾病），纽约心脏协会（NewYorkHea...