摘要
目的探讨肌红蛋白水平对急性主动脉夹层术后急性肾损伤(AKI)及预后的影响。方法回顾性分析131例体外循环下行急性Stanford A型主动脉夹层修复手术患者的临床资料,根据患者术后进入ICU首次检测血清肌红蛋白水平中位数分为高肌红蛋白组(>821.88 ng/mL,65例)和低肌红蛋白组(≤821.88 ng/mL,66例)。比较两组相关临床资料,分析术后AKI发生的影响因素。结果 131例中,发生AKI 64例(48.85%);高肌红蛋白组术后AKI发生率高于低肌红蛋白组(64.62%vs.33.33%)(P<0.01)。两组患者BMI、高血压和术前器官灌注不良比例、术前D-D水平、术前乳酸、术前纤维蛋白原降解产物、手术时间、体外循环时间、辅助循环时间比较差异均有统计学意义(P<0.05)。高肌红蛋白组术后ICU留治时间、机械通气时间、28-d院内病死率均高于低肌红蛋白组(P<0.01)。单因素和多因素logistic回归分析均显示,术后高肌红蛋白是主动脉夹层术后发生AKI的独立危险因素(P<0.05)。结论肌红蛋白增高与急性主动脉夹层患者术后发生AKI密切相关。
Objective To explore the effects of myoglobin on acute kidney injury(AKI) and prognosis of the patients underwent the surgery for acute aortic dissection.Methods The clinical data of 131 patients with Stanford A underwent acute aortic dissection surgery under cardiopulmonary bypass were retrospectively analyzed.According to serum level of myoglobin detected at the first time after entrying ICU,the patients were divided into two groups of A(>821.88 ng/mL,65 cases) and B(≤821.88 ng/mL,66 cases).The relevant data and the incidence of postoperative AKI were compared between the two groups.The influencing factors for AKI after acute aortic dissection surgery were analyzed.Results Of 131 patients, 64 patients(48.85%) had AKI after operation, which was higher in group A than that in group B(64.62% vs.33.33%)(P<0.01).The differences in BMI,hypertension and preoperative organ perfusion ratio, preoperative D-D level, preoperative lactic acid, preoperative FDP,operation time, extracorporeal circulation time and auxiliary circulation time were statistically significant between the two groups(P<0.05).The postoperative ICU stay, mechanical ventilation time, and 28-day hospital mortality were higher in group A than those in group B(P<0.01).The univariate and multivariate logistic regression analysis showed that postoperative hypermyoglobin was an independent risk factor for AKI after aortic dissection(P<0.05).ConclusionIncreased myoglobin is closely associated with postoperative AKI in the patients with acute aortic dissection.
作者
周旺涛
叶斯力·哈力木别克
通耀威
王于强
雷泓
宋云林
ZHOU Wangtao;Yesili·Halimubieke;TONG Yaowei(Department of Intensive Care Unit,First Affiliated Hospital,Xinjiang Medical University,Urumchi 830054,CHINA)
出处
《江苏医药》
CAS
2021年第3期242-246,共5页
Jiangsu Medical Journal
基金
新疆医科大学教育改革项目(YG2019096)。
