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目的探索法洛四联症(tetralogy of Fallot,TOF)患者术后急性肾损伤(acute kidney injury,AKI)的危险因素。方法本研究采用回顾性队列研究法。纳入2010年3月1日至2013年3月1日于阜外医院TOF根治术患者726例。以急性肾损伤网络工作小组(AKIN)作为AKI的诊断标准,将患者分为AKI组(240例)和非AKI组(486例)。采取单因素分析法,比较两组之间的差异性变量。单因素分析中P<0.1的变量纳入二元logistic模型,用以分析变量的显著性差异。结果单因素分析结果显示:AKI组和非AKI组患者年龄、Nakata指数、Mc Goon比值、左心室舒张期末容积指数(left ventricular end-diastolic volume index,LVEDVI)、跨环补片、术中输注新鲜冷冻血浆(fresh frozen plasma,FFP)差异有统计学意义。二元logistic分析显示:AKI组患儿年龄较大(OR=1.425,95%CI 1.071~1.983,P=0.011),AKI组Nakata指数(OR=0.282,95%CI 0.092~0.869,P=0.013)较小,AKI组术中输注FFP较多(OR=1.468,95%CI 1.325~2.674,P<0.001)。结论 Nakata指数越小TOF患者根治术后AKI的发病率越高。TOF根治手术时患儿年龄越大术后AKI的发病率越高。术中输注FFP可能会导致术后AKI的发病率增高。
Objective To explore the risk factors of postoperative acute kidney injury (AKI) in patients with tetralogy of Fallot (TOF). Methods This study used a retrospective cohort study. Including March 1, 2010 to March 1, 2013 in Fu Wai Hospital, 726 patients with TOF. Patients were divided into AKI group (240 cases) and non-AKI group (486 cases) using AKIN as AKI diagnostic criteria. Univariate analysis was used to compare the differences between the two groups. Univariate analysis of P <0.1 variables into the binary logistic model to analyze the significant differences in variables. Results The results of univariate analysis showed that age, Nakata index, Mc Goon ratio, left ventricular end-diastolic volume index (LVEDVI), trans-annular patch, intraoperative infusion Fresh frozen plasma (fresh frozen plasma, FFP) difference was statistically significant. Binary logistic analysis showed that the AKI group was older (OR = 1.425, 95% CI 1.071-1.983, P = 0.011), and AKI group had a higher Nakata index (OR = 0.282, 95% CI 0.092-0.869, P = 0.013) In the AKI group, intraoperative infusions of FFP were more frequent (OR = 1.468, 95% CI 1.325-2.674, P <0.001). Conclusions The smaller the Nakata index, the higher the incidence of AKI after radical operation in patients with TOF. The higher the age of children with TOF after radical surgery, the higher the incidence of AKI. Intraoperative infusion of FFP may lead to an increased incidence of postoperative AKI.