儿童先天性心脏病术后急性肾损伤相关临床危险因素分析-东南大学学报医学版

儿童先天性心脏病术后急性肾损伤相关临床危险因素分析

单位：1. 南京大学医学院附属南京市鼓楼医院肾内科,江苏南京 210008;
2. 南京大学医学院附属南京市鼓楼医院心胸外科,江苏南京 210008

分类号：R725.4;R726.9

出版年·卷·期（页码）：2014·33·第二期（177-181）

摘要：

目的：应用改良的小儿RIFLE（pRIFLE）分级探讨儿童先天性心脏病术后急性肾损伤（acute kidney injury，AKI）的危险因素。方法：以2008年1月至2012年12月因先天性心脏病在我院行手术治疗且年龄小于12岁的患儿为研究对象，观察AKI发生率及各期的临床特点，比较AKI与非AKI的临床特征，以单因素及多因素Logistic回归分析AKI的危险因素。结果：本研究共入选234例患儿，平均年龄59.82个月，其中男性130例，女性104例。225例（96.2%）患儿行心肺转流（cardiopulmonary bypass，CPB）心脏直视手术，67例（28.6%）患儿发生AKI。AKI与非AKI患儿的RACHS-1手术分级、性别差异无统计学意义（均P>0.05），AKI患儿年龄较小，体质量偏低，其CPB时间、主动脉阻断时间（aortic cross-clamp time，ACT）和机械通气时间均长于非AKI患儿（P<0.05）。CPB时间及ACT与AKI分级有关。多因素Logistic回归分析提示低体质量及CPB时间是患儿发生AKI的独立危险因素，OR值分别为4.39、2.85。结论：急性肾损伤是儿童先天性心脏病术后常见并发症，低体质量及CPB时间是其独立危险因素。

Objective: To analyze the risk factors of acute kidney injury (AKI) after congenital heart surgery in children using the pediatric RIFLE (pRIFLE) score. Methods: A total of 234 children (≤12 years old) who underwent congenital heart surgery in our hospital from Jan 2008 to Dec 2012 were enrolled in this research. The incidence of AKI and the chlinical characteristics of each period were observed. The clinical characteristics of patients with and without AKI were compared, and univariate and multivariate logistic regression analysis were used to find out the risk factors of AKI. Results: The cohort of 234 children had an average age of 59.82 months with 104 males and 130 females, and 225 patients required cardiopulmonary bypass (CPB)heart surgery. 67 of them developed AKI. There were no difference in average RACHS-1 category and sex in patients with and without AKI (P>0.05). Children with AKI were younger with lower body weight and longer CPB time, aortic cross-clamp time (ACT) and mechanical ventilation time (P<0.05). The longer CPB time and ACT, the more serious AKI was. Multivariate logistic regression analysis showed that low weight and long CPB time were independent risk factors for AKI. Conclusion: AKI is common after congenital heart surgery in children. Low weight and long CPB time are independent risk factors for AKI in these patients.

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