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中华肾病研究电子杂志

中华肾病研究电子杂志 ›› 2021, Vol. 10 ›› Issue (03) : 126 -132. doi: 10.3877/cma.j.issn.2095-3216.2021.03.002

论著

冠状动脉造影术到心脏瓣膜手术时间间隔对术后急性肾损伤发生的影响
李美媛1, 刘康1, 邬步云1, 俞香宝1, 朱亚梅1, 毛慧娟1,†(), 邢昌赢1   
  1. 1. 210029　南京医科大学第一附属医院（江苏省人民医院）肾内科
  • 收稿日期:2020-12-30 出版日期:2021-06-28
  • 通信作者: 毛慧娟
  • 基金资助:
    国家自然基金面上项目(81970639); 2017年江苏省卫生和健康委员会科研项目(H2017023)

Impact of the time interval from coronary angiography to valve surgery on the occurrence of postoperative acute kidney injury

Meiyuan Li1, Kang Liu1, Buyun Wu1, Xiangbao Yu1, Yamei Zhu1, Huijuan Mao1,†(), Changying Xing1   

  1. 1. Department of Nephrology, First Affiliated Hospital of Nanjing Medical University (Jiangsu Provincial People′s Hospital), Nanjing 210029, Jiangsu Province, China
  • Received:2020-12-30 Published:2021-06-28
  • Corresponding author: Huijuan Mao
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引用本文：

李美媛, 刘康, 邬步云, 俞香宝, 朱亚梅, 毛慧娟, 邢昌赢. 冠状动脉造影术到心脏瓣膜手术时间间隔对术后急性肾损伤发生的影响[J]. 中华肾病研究电子杂志, 2021, 10(03): 126-132.

Meiyuan Li, Kang Liu, Buyun Wu, Xiangbao Yu, Yamei Zhu, Huijuan Mao, Changying Xing. Impact of the time interval from coronary angiography to valve surgery on the occurrence of postoperative acute kidney injury[J]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2021, 10(03): 126-132.

目的

探讨冠状动脉造影术到心脏瓣膜手术时间间隔对术后急性肾损伤(AKI)发生的影响。

方法

回顾性收集2017年1月至2018年12月在南京医科大学第一附属医院住院行冠脉造影和心脏瓣膜手术患者的术前基线资料、手术相关资料以及临床预后资料。采用倾向性评分匹配、单因素和多因素Logistic回归分析，探讨冠脉造影到手术时间间隔对瓣膜手术术后发生急性肾损伤的影响。

结果

共纳入符合标准的患者338例，其中女性患者164例。术后AKI发病率为25.4%(86/338)。根据冠脉造影到心脏瓣膜手术时间间隔中位数6 d，将所有患者分为≤6 d组(206例)和>6 d组(132例)。两组患者在术前基线指标、术中相关指标以及在AKI发生率方面差异均无统计学意义。单因素回归分析显示，年龄、基线肌酐、估算的肾小球滤过率、手术时间、体外循环时间、主动脉阻隔时间、停跳时间均为瓣膜手术后AKI的相关危险因素。时间间隔6 d与心脏术后AKI发生无明显相关性。多因素Logistic回归分析显示时间间隔6 d与术后AKI的发生无显著相关性。

结论

冠状动脉造影术到心脏瓣膜手术时间间隔可能不是术后发生AKI的独立危险因素。

关键词: 急性肾损伤, 心脏瓣膜手术, 冠状动脉造影术, 时间间隔
Objective

To investigate the impact of the time interval from coronary angiography to valvular surgery on the occurrence of postoperative acute kidney injury (AKI).

Methods

Preoperative baseline data, surgical data, and clinical prognosis data of patients, who were admitted to the First Affiliated Hospital of Nanjing Medical University from January 2017 to December 2018 and underwent both coronary angiography and cardiac valve surgery, were collected retrospectively. Propensity score matching, univariate and multivariate logistic regression methods were used to investigate the impact of the time interval from coronary angiography to valvular surgery on the occurrence of postoperative AKI.

Results

A total of 338 patients were enrolled in the study, among whom there were 164 female patients. The incidence of postoperative AKI was 25.4% (86/338). According to the median time interval of 6 days, all the patients were divided into two groups: ≤6 d group (206 cases) and >6 d group (132 cases). There were no significant differences between the two groups in preoperative baseline indicators, intraoperative related indicators, and the incidence of AKI. Univariate regression analysis showed that age, baseline creatinine, estimated glomerular filtration rate, operation time, extracorporeal circulation time, aortic cross-clamp time, and cardiac arrest time were all the related risk factors for AKI after valve surgery, but there was no significant correlation between the 6-day interval and the occurrence of AKI after cardiac valve surgery. And the multivariate logistic regression analysis also showed that there was no significant correlation between the 6-day interval and the occurrence of postoperative AKI.

Conclusion

The time interval between coronary angiography and valvular surgery may not be an independent risk factor for the postoperative AKI.

Key words: Acute kidney injury, Cardiac valve surgery, Coronary angiography, Time interval
表1 两组患者基线资料对比
变量 匹配前 匹配后
≤6 d(n＝206) >6 d(n＝132) P值 标准化均数差(%) ≤6 d(n＝117) >6 d(n＝117) 标准化均数差(%)
人口统计学              
  年龄(岁) 60.8±7.7 62.0±7.2 0.143 16.5 61.4±7.9 62.2±6.9 10.3
  女性[例(%)] 100(48.5) 64(48.5) 0.992   58(49.6) 54(46.2)  
  吸烟[例(%)] 51(24.8) 33(25.0) 0.960   28(23.9) 31 (26.5)  
  高血[例(%)] 70(34.0) 51(38.6) 0.384   40(34.2) 47(40.2)  
  糖尿病[例(%)] 15(7.3) 9(6.8) 0.871   6(5.1) 9(7.7)  
  慢性阻塞性肺疾病[例(%)] 4(1.9) 2(1.5) 1.000   4(3.4) 2(1.7)  
  贫血[例(%)] 13(6.3) 5(3.8) 0.314   5(4.3) 5(4.3)  
  脑血管疾病[例(%)] 14(6.8) 11(8.3) 0.598   8(6.8) 11(9.4)  
  合并症数目 0(0，1) 0.5(0，1) 0.655   0(0，1) 1(0，1)  
基础心肾功能              
  基线肌酐(μmol/L) 69.9(60.8，82.1) 72.6(57.9，83.1) 0.856 3.43 71.8(60.8，81.8) 72.5(58.4，82.0) 6.53
  eGFR[ml/(min·1.73 m2)] 92.4(78.3，102.0) 90.8(77.1，100.8) 0.480   91.1(77.9，101) 90.9(77.9，100.8)  
  NYHA分级Ⅲ～Ⅳ[例(%)] 94(45.6) 65(49.2) 0.516   52(44.4) 60(51.3)  
  肺动脉压(mmHg) 35(30，43) 39(30，49.5) 0.003 33.6 38(30，45) 37(30，46) 9.98
术前资料              
  血红蛋白(g/L) 133(123，144) 134(123，142) 0.716   133(123，141) 134(124，143)  
  白蛋白(g/L) 38.8(36.6，41.4) 38.8(36.8，41.6) 0.989   38.7(36.5，41.1) 38.6(36.6，41.8)  
  红细胞压积(%) 40.1(38，44) 39.5(35，43) 0.041 20.1 40.0(37，43) 39.8(35，44) 1.26
术中资料              
  手术时间(min) 277(240，326) 288(246，345) 0.268   273(234，327) 284(239，338)  
  体外循环时间(min) 137(110，175) 141(115，180) 0.235 13.2 134(104，175) 140(113，176) 9.85
  主动脉阻断时间(min) 102(76，132) 107(84，131) 0.463   100(71.5，132) 105(79.5，125)  
  停跳时间(min) 107(80，137) 108(86，136) 0.486   105(74，138) 107(81，134)  
  输血小板[例(%)] 192(93.2) 123(93.2) 0.994   106(90.6) 110(94)  
  输血浆[例(%)] 28(13.6) 22(16.7) 0.437   14(12.0) 19(16.2)  
  失血量(ml) 800(500，1000) 800(500，1000) 0.409   800(500，1000) 800(500，1000)  
预后              
  AKI[例(%)] 53(25.7) 33(25.0) 0.881   30(25.6) 31(26.5)  
  住院死亡[例(%)] 7(3.4) 7(5.3) 0.391   6(5.1) 7(6.0)  
  接受RRT[例(%)] 3(1.5) 3(2.3) 0.682   3(2.6) 3(2.6)  
  住院时间(d) 19(16，22) 25(20，31)a <0.001   18(16，22) 24(20，30)  
表2 心脏瓣膜术后AKI危险因素单因素分析
变量 匹配前 匹配后
OR(95%CI) P值 OR(95%CI) P值
年龄(岁) 1.066(1.029～1.104) <0.001 1.069(1.024～1.116) 0.002
女性 0.698(0.425～1.144) 0.153 0.751(0.417～1.354) 0.341
吸烟 1.449(0.840～2.501) 0.183 1.504(0.788～2.873) 0.216
高血压 1.325(0.801～2.190) 0.273 1.031(0.564～1.884) 0.921
糖尿病 2.237(0.955～5.242) 0.064 1.455(0.477～4.441) 0.510
慢性阻塞性肺疾病 3.000(0.594～15.15) 0.184 2.931(0.576～14.93) 0.195
脑血管疾病 0.920(0.355～2.384) 0.863 1.343(0.487～3.704) 0.569
贫血 1.500(0.545～4.127) 0.432 1.227(0.307～4.901) 0.773
合并症数目(个) 1.457(1.011～2.099) 0.044 1.236(0.802～1.906) 0.337
肌酐(μmol/L) 1.019(1.006～1.032) 0.004 1.025(1.008～1.043) 0.005
eGFR[ml/(min·1.73 m2)] 0.979(0.966～0.993) 0.003 0.978(0.961～0.995) 0.011
NYHA分级Ⅲ～Ⅳ 1.415(0.866～2.312) 0.166 1.174(0.654～2.105) 0.591
肺动脉压(mmHg) 0.995(0.976～1.014) 0.603 0.996(0.969～1.023) 0.773
血红蛋白(g/L) 0.994(0.980～1.008) 0.413 0.993(0.975～1.010) 0.416
白蛋白(g/L) 0.995(0.935～1.059) 0.877 1.003(0.934～1.078) 0.935
红细胞压积(%) 0.985(0.947～1.025) 0.451 0.978(0.934～1.025) 0.355
时间间隔6 d 1.039(0.629～1.718) 0.881 0.957(0.534～1.715) 0.882
手术时间(min) 1.006(1.003～1.010) <0.001 1.007(1.003～1.011) <0.001
体外循环时间(min) 1.008(1.003～1.012) 0.002 1.009(1.003～1.015) 0.002
主动脉阻断时间(min) 1.008(1.002～1.014) 0.007 1.009(1.002～1.016) 0.014
停跳时间(min) 1.008(1.002～1.013) 0.007 1.009((1.002～1.015) 0.010
输血小板 1.246(0.448～3.465) 0.673 1.255(0.397～3.969) 0.699
输血浆 1.167(0.596～2.286) 0.653 1.075(0.469～2.461) 0.865
失血量(ml) 1.001(1.000～1.001) 0.100 1.001(1.000～1.002) 0.081
表3 匹配前多因素回归分析心脏瓣膜术后AKI发病危险因素
变量 模型1 模型2 模型3
OR(95%CI) P值 OR(95%CI) P值 OR(95%CI) P值
时间间隔6 d(二分类) - - - - - -
年龄(岁) - - 1.069(1.031～1.109) <0.001 1.061(1.023～1.100) 0.001
肌酐(μmol/L)     1.014(1.001～1.027) 0.033 1.014(1.002～1.027) 0.026
eGFR[ml/(min·1.73 m2)] 0.980(0.966～0.994) 0.004 - - - -
合并症数目(个) - - - - - -
体外循环时间(min) 1.007(1.002～1.012) 0.003 1.008(1.003～1.013) 0.001 - -
主动脉阻隔时间(min) - - - - - -
停跳时间(min) - - - - - -
手术时间(min) - - - - 1.006(1.003～1.010) <0.001
表4 匹配后多因素回归分析心脏瓣膜术后AKI发病危险因素
变量 模型1 模型2 模型3
OR(95%CI) P值 OR(95%CI) P值 OR(95%CI) P值
时间间隔6天(二分类) - - - - - -
年龄(岁) - - 1.072(1.025～1.122) 0.003 1.062(1.016～1.110) 0.008
肌酐(μmol/L) - - 1.018(1.000～1.036) 0.049 1.018(1.000～1.036) 0.049
eGFR[ml/(min·1.73 m2)] 0.977(0.960～0.995) 0.011 - - - -
体外循环时间(min) 1.009(1.003～1.016) 0.002 1.010(1.004～1.016) 0.002 - -
主动脉阻隔时间(min) - - - - - -
停跳时间(min) - - - - - -
手术时间(min) - - - - 1.007(1.003～1.011) 0.001
表5 各个时间间隔对于瓣膜术后AKI发病的影响
时间间隔(d) 匹配前 匹配后
OR(95%CI) P值 OR(95%CI) P值
1 0.511(0.198～1.323) 0.167 0.439(0.139～1.381) 0.159
2 0.659(0.348～1.249) 0.201 0.708(0.331～1.515) 0.374
3 0.764(0.434～1.343) 0.350 0.712(0.354～1.434) 0.342
4 0.767(0.447～1.316) 0.336 0.651(0.329～1.288) 0.218
5 0.896(0.531～1.514) 0.682 0.777(0.408～1.479) 0.443
6 1.181(0.692～2.015) 0.541 1.054(0.565～1.963) 0.870
7 1.673(0.912～3.072) 0.097 1.396(0.716～2.722) 0.327
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