2023 年第 3 期 第 18 卷

急性A型主动脉夹层患者术后急性肾衰竭的危险因素及预后

Risk factors and prognosis of acute renal failure after acute type A aortic dissection surgery

作者：曲开勇卫金花张艺馨张燕搏

英文作者：Qu Kaiyong Wei Jinhua Zhang Yixin Zhang Yanbo

单位：中国医学科学院北京协和医学院国家心血管病中心阜外医院成人心外科恢复室，北京100037

英文单位：Adult Surgical Entensive Care Unit Fuwai Hospital National Center for Cardiovascular Diseases Peking Union Medical College Chinese Academy of Medical Sciences Beijing 100037 China

关键词：急性A型主动脉夹层；急性肾衰竭；危险因素；预后

英文关键词：AcutetypeAaorticdissection；Acuterenalfailure；Riskfactors；Prognosis

• 摘要：

• 目的 探讨急性A型主动脉夹层（ATAAD）患者术后急性肾衰竭（ARF）的危险因素和临床预后。方法 连续收集2013年1月至2018年12月在中国医学科学院阜外医院接受ATAAD手术的797例患者纳入统计分析。采用多因素Logistic回归方法分析ARF的危险因素，采用Kaplan-Meier生存曲线分析ARF与术后长期生存的相关性。结果 797例ATAAD患者中89例（11.2%）术后发生ARF。Logistic回归分析结果显示，高龄、冠状动脉受累、肾脏灌注不良、术前血肌酐水平升高和体外循环时间延长均为ATAAD患者术后ARF的独立危险因素，而吸烟是其独立保护因素（均P＜0.05）。797例ATAAD患者术后院内死亡率为5.1%（41例），所有患者中位随访时间为44个月，Kaplan-Meier生存曲线显示ARF患者累积生存率低于无ARF患者（Log-rank P＜0.001）。结论 高龄、冠状动脉受累、肾脏灌注不良、术前血肌酐水平升高和体外循环时间延长是ATAAD患者术后发生ARF的独立危险因素。ARF降低了患者短期及长期生存率。

• Objective  To investigate the risk factors and clinical prognosis of acute renal failure (ARF) after acute type A aortic dissection (ATAAD) surgery. Methods  From January 2013 to December 2018, 797 patients who underwent ATAAD surgery in Fuwai Hospital, Chinese Academy of Medical Sciences were collected and included in the statistical analysis. Multivariate Logistic regression analysis was used to analyze the risk factors of ARF, and Kaplan-Meier survival curve was used to analyze the correlation between ARF and long-term survival. Results  Among 797 ATAAD patients, 89 cases (11.2%) developed ARF after surgery. Logistic regression analysis showed that old age, coronary artery involvement, poor renal perfusion, elevated preoperative serum creatinine level and prolonged cardiopulmonary bypass were independent risk factors for ARF in patients with ATAAD, while smoking was the independent protective factor (all P＜0.05). The hospital mortality rate after surgery of 797 patients with ATAAD was 5.1% (41 cases), and the median follow-up time of all patients was 44 months. Kaplan-Meier survival curve showed that the cumulative survival rate of patients with ARF was lower than that of patients without ARF (Log-rank P＜0.001). Conclusions  Old age, coronary artery involvement, poor renal perfusion, elevated preoperative serum creatinine level and prolonged cardiopulmonary bypass are independent risk factors for ARF in patients with ATAAD. ARF reduces the short-term and long-term survival rate of patients.