Safi H J, Harlin S A, Miller C C, Iliopoulos D C, Joshi A, Mohasci T G, Zippel R, Letsou G V
Baylor College of Medicine, Methodist Hospital, Houston, TX, USA.
J Vasc Surg. 1996 Sep;24(3):338-44; discussion 344-5. doi: 10.1016/s0741-5214(96)70189-1.
The purpose of this study was to analyze the factors associated with acute renal failure in total descending thoracic and thoracoabdominal aortic aneurysm surgery.
A total of 234 patients underwent thoracoabdominal aortic aneurysm or total descending thoracic aneurysm repair between January 1991 and January 1994. Eighty-five women and 149 men were evaluated. The median age was 67 years (range 8 to 88 years). Seventy-seven patients had type I thoracoabdominal aortic aneurysm, 99 had type II, 51 had type III or IV, and 7 had total descending thoracic aneurysm. Factors such as age, sex, aneurysm type, and visceral and distal aortic perfusion were examined with univariate fourfold table and multivariate logistic regression analysis.
Acute renal failure, defined as an increase in serum creatinine by 1 mg/dl per day for two consecutive days after surgery, occurred in 41 (17.5%) of 234 patients. Thirty-six (15%) of 234 patients required dialysis. Twenty (49%) of 41 patients with acute renal failure died. Of the 21 survivors with renal failure, renal failure resolved in 18 (86%) within 30 days of surgery. The univariate odds ratio of death, given acute renal failure, was 6.7 (95% confidence interval [CI] 3.2 to 14.2, p < 0.0001). No significant association was found between the probability of acute renal failure and age, sex, hypertension, right renal artery reattachment, or renal bypass. Factors associated with increased risk of acute renal failure in multivariate analysis were visceral perfusion (odds ratio [OR] = 3.6 95%, CI 1.2 to 11.0, p < 0.02), left renal artery reattachment (OR = 4.4 95%, CI 1.6 to 11.9, p < 0.004), preoperative creatinine > or = 2.8 mg/dl (OR = 10.3, 95% CI 12.0 to 411.8, p < 0.0001), and simple clamp technique (OR = 3.4 95%, CI 1.07 to 10.76, p < 0.04). Direct univariate correlation was seen between preoperative creatinine and acute renal failure (OR = 3.2 per mg/dl increase, 95% CI 2.7 to 10.1, p < 0.0001).
Postoperative acute renal failure after thoracoabdominal and total descending thoracic aortic aneurysm surgery is associated with preoperative creatinine level, visceral perfusion, left renal artery reattachment, and simple cross-clamp technique.
本研究旨在分析全胸降主动脉和胸腹主动脉瘤手术中与急性肾衰竭相关的因素。
1991年1月至1994年1月期间，共有234例患者接受了胸腹主动脉瘤或全胸降主动脉瘤修复术。对85名女性和149名男性进行了评估。中位年龄为67岁（范围8至88岁）。77例患者为I型胸腹主动脉瘤，99例为II型，51例为III型或IV型，7例为全胸降主动脉瘤。采用单因素四格表和多因素逻辑回归分析对年龄、性别、动脉瘤类型以及内脏和远端主动脉灌注等因素进行了研究。
234例患者中有41例（17.5%）发生急性肾衰竭，定义为术后连续两天血清肌酐每天升高1mg/dl。234例患者中有36例（15%）需要透析。41例急性肾衰竭患者中有20例（49%）死亡。在21例肾衰竭幸存者中，18例（86%）在术后30天内肾衰竭得到缓解。急性肾衰竭患者的单因素死亡比值比为6.7（95%置信区间[CI]3.2至14.2，p<0.0001）。未发现急性肾衰竭的概率与年龄、性别、高血压、右肾动脉再植或肾旁路之间存在显著关联。多因素分析中与急性肾衰竭风险增加相关的因素包括内脏灌注（比值比[OR]=3.6，95%CI 1.2至11.0，p<0.02）、左肾动脉再植（OR=4.4，95%CI 1.6至11.9，p<0.004）、术前肌酐≥2.8mg/dl（OR=10.3，95%CI 12.0至411.8，p<0.0001）以及单纯夹闭技术（OR=3.4，95%CI 1.07至10.76，p<0.04）。术前肌酐与急性肾衰竭之间存在直接单因素相关性（每升高1mg/dl，OR=3.2，95%CI 2.7至10.1，p<0.0001）。
胸腹主动脉瘤和全胸降主动脉瘤手术后的术后急性肾衰竭与术前肌酐水平、内脏灌注、左肾动脉再植以及单纯交叉夹闭技术有关。
