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目的探讨<4岁先天性心脏病小儿术后发生急性肾损伤(acute kidney injury,AKI)的临床危险因素。方法收集2015年4月至2016年4月在新桥医院行先天性心脏病手术治疗的<4岁患儿临床资料,以改良儿童肾脏疾病风险分级(pediatric risk injury failure loss and end stage kidney diseases,pRIFLE)作为AKI诊断标准,分析术后AKI发生率,比较术后发生AKI(AKI组)与未发生AKI(N-AKI组)患儿的差异,并利用多因素Logistic回归分析筛选小儿先天性心脏病术后发生AKI的临床危险因素。结果共纳入298例患儿,其中男性152例,女性146例。107例(35.91%)患儿术后发生AKI,其中危险期82例(27.52%),损伤期16例(5.37%),衰竭期9例(3.02%)。与N-AKI组相比,AKI组患儿平均年龄、身高、体质量更低,术前合并紫绀及其他重要疾病概率更高,血清肌酐(serum creatinine,Scr)更低,ASA分级更高;手术时间、体外循环(cardiac pulmonary bypass,CPB)时间、主动脉钳闭时间(aortic clamping time,ACT)更长;术后尿素、尿酸、Scr、胱抑素、视黄醇结合蛋白更高,肌酐清除率(estimated creatinine clearance,eCCl)更低,住院时间更长,死亡率更高。其中年龄<1岁、术前合并紫绀、术前Scr低、手术时间较长是术后发生AKI的独立危险因素。结论年龄<1岁、术前合并紫绀、术前Scr低、手术时间较长会显著增加小儿先天性心脏病术后AKI发生风险。
Objective To investigate the clinical risk factors of acute kidney injury (AKI) in children with congenital heart disease after 4 years of age. Methods The clinical data of children <4 years old who underwent surgical treatment of congenital heart disease in Xinqiao Hospital from April 2015 to April 2016 were collected to improve the pediatric risk injury failure loss and end stage kidney diseases (pRIFLE ) Was used as AKI diagnostic criteria to analyze the incidence of postoperative AKI and to compare the differences between children with AKI (AKI group) and without AKI group (N-AKI group). Multivariate Logistic regression analysis was used to screen for children with congenital heart disease Postoperative AKI clinical risk factors. Results A total of 298 children were enrolled, including 152 males and 146 females. AKI occurred in 107 cases (35.91%) of children, including 82 cases (27.52%) in danger stage, 16 cases (5.37%) in injury stage and 9 cases (3.02%) in failure stage. Compared with N-AKI group, children with AKI had lower average age, height and weight, preoperative cyanosis and other important diseases, lower serum creatinine (Scr) and higher ASA grade. The duration of operation, CPB time, and aortic clamping time (ACT) were longer. The levels of urea, uric acid, Scr, cystatin and retinol binding protein were higher and creatinine Lower estimated creatinine clearance (eCCl), longer hospital stay, and higher mortality. Age <1 year, preoperative cyanosis, low preoperative Scr, and longer operative time were independent risk factors for AKI. Conclusions Age <1 year, cyanosis preoperatively, low preoperative Scr and longer operative time will significantly increase the risk of AKI in children with congenital heart disease.