论文部分内容阅读
目的分析不同年龄段成人患者心脏术后急性肾损伤(acute kidney injury。AKI)发病状况,以指导研究进一步防治措施。方法前瞻性收集接受心脏外科手术住院患者病史资料,分析不同年龄段患者心脏手术后AKI发病率、发病危险因素及短期预后。结果共入选3896例接受心脏手术治疗患者。其中中青年(<65岁,但≥18岁)患者3086例、老年(≥65岁,但<80岁)患者772例、高龄(≥80岁)患者38例。老年组术前血肌酐、男性、术前心功能NYHAⅢ级、术前合并糖尿病、高血压及造影史比例、接受冠状动脉旁路移植术、术后因低血压使用肾上腺素及去甲肾上腺素比例均高于中青年组(P值均<0.05),高龄组术前血肌酐、术前心功能NYHAⅢ-Ⅳ级及接受冠状动脉旁路移植术比例均高于老年组(P值均<0.05)。中青年组心脏术后AKI发病率均低于老年组和高龄组(23.1%比39.9%,P<0.05;23.1%比42.1%,P<0.05);3组患者院内死亡率组间比较无显著性差异。多因素Logistic回归分析显示,≥65岁患者心脏术后AKI发生的独立危险因素包括男性、年龄、术前SCr>1.2mg/dl(1mg/dl=88μmol/L)、术后因低血压使用肾上腺素。结论老年人心脏术后AKI随患者年龄增加而逐步升高且预后较差,其发病与围手术期多种危险因素密切相关。老年人心脏术后并发AKI时仍应积极救治,以期进一步改善患者预后。
Objective To analyze the incidence of acute kidney injury (AKI) in adult patients of different ages and to guide the further prevention and treatment measures. Methods The data of hospitalized patients undergoing cardiac surgery were prospectively collected to analyze the incidence of AKI, risk factors and short-term prognosis after heart surgery in different age groups. Results A total of 3896 patients undergoing cardiac surgery were enrolled. Among them, there are 3086 middle-aged and young patients (<65 years old, ≥18 years old), 772 elderly patients (≥65 years old, but <80 years old) and 38 elderly patients (≥80 years old). Preoperative serum creatinine, male, preoperative NYHA class Ⅲ cardiac function, preoperative diabetes, hypertension and angiography history, undergoing coronary artery bypass grafting, postoperative hypotension using epinephrine and norepinephrine ratio (P <0.05). The preoperative serum creatinine, preoperative cardiac function NYHAⅢ-Ⅳ grade and coronary artery bypass grafting in the elderly group were higher than those in the elderly group (all P <0.05) . The incidence of AKI in young and middle-aged patients was significantly lower than that in the elderly and elderly patients (23.1% vs 39.9%, P <0.05; 23.1% vs 42.1%, P <0.05). There was no significant difference in in-hospital mortality among the three groups Sex differences. Multivariate Logistic regression analysis showed that the independent risk factors for AKI after ≥6years of cardiac surgery included male, age, preoperative SCr> 1.2mg / dl (1mg / dl = 88μmol / L), postoperative hypotension using adrenal Prime Conclusions The AKI of elderly patients with heart surgery gradually increases with the increase of age and the prognosis is poor. The incidence of AKI is closely related to various perioperative risk factors. The elderly patients with AKI after cardiac surgery should be active treatment, with a view to further improve the prognosis of patients.