肺移植患者术后急性肾损伤影响因素分析
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篇名: 肺移植患者术后急性肾损伤影响因素分析
TITLE: Analysis of Influential Factors for Acute Kidney Injury after Lung Transplantation
摘要: 目的:分析肺移植患者术后急性肾损伤(AKI)的发生情况及可能的影响因素。方法:回顾性收集2017年4月-2018年6月于我院接受肺移植术64例患者的病历资料,按术后是否发生AKI分为AKI组(44例)和无AKI组(20例)。根据我院肺移植诊疗规范,所有患者均给予注射用甲泼尼龙琥珀酸钠或注射用甲泼尼龙琥珀酸钠联合注射用巴利昔单抗诱导治疗,并于术后行他克莫司胶囊+吗替麦考酚酯分散片或吗替麦考酚酯胶囊或麦考酚钠肠溶片+甲泼尼龙片或醋酸泼尼松片三联免疫抑制治疗方案。记录AKI组患者术后1周内AKI发生情况,并观察两组患者术中[手术类型、手术时间、体外膜肺氧合(ECMO)支持、免疫抑制剂使用情况、术中出血量]、术后影响因素[重症加强护理病房(ICU)天数、机械通气天数、ECMO支持天数、术后1周内血清肌酐(Scr)中位值,他克莫司全血浓度中位值、潜在肾毒性药物使用种类(≥4种)、住院天数]及术后1年生存率。结果:肺移植术后1周内,64例患者有中44例(68.8%)至少发生过1次AKI,其中1期19例(29.7%)、2期17例(26.5%)、3期8例(12.5%);术后第4天AKI发生率最高(57.4%);在肺移植术后1周内3期AKI发生率总体呈上升趋势,并在术后第5天达到最高(8.7%)。无AKI组患者的手术时间、术后1周内Scr中位值、他克莫司全血浓度中位值均显著短于或低于AKI组(P<0.05);两组患者手术类型、ECMO支持使用情况、免疫抑制剂使用情况、术中失血量、ICU天数、机械通气天数、ECMO支持天数、潜在肾毒性药物(≥4种)使用率、住院天数比较,差异均无统计学意义(P>0.05)。1期和2期AKI患者术后1年生存率与无AKI组比较,差异均无统计学意义(P>0.05);3期AKI患者术后1年生存率显著低于无AKI组(P<0.05)。结论:肺移植术后AKI的发生率较高。手术时间、术后1周内Scr中位值、他克莫司全血浓度中位值均为术后发生AKI的可能影响因素。
ABSTRACT: OBJECTIVE:To analyze the occurrence of acute kidney injury (AKI)after lung transplantation and its possible influential factors . METHODS :Medical records of 64 patients who received lung transplantation in our hospital from April 2017 to June 2018 were included in this retrospective study. Patients were divided into AKI group (44 cases)and non-AKI group (20 cases),according to whether AKI occurred after operation. According to diagnostic criteria for lung transplantation in our hospital , all patients were given Methylprednisolone sodium succinate for injection or Methylprednisolone sodium succinate for injection combined with Basiliximab for injection ,and triple immunosuppressive therapy of Tacrolimus capsules+Mycophenolate mofetil dispersible tablets or Mycophenolate mofetil capsules or Mycophenolate sodium enteric-coated tablets+Methylprednisolone tablets or Prednisone acetate tablets were given after operation. The occurrence of AKI in AKI group within a week after operation were recorded. Intraoperative influential factors (operation type , operation duration , ECMO support , immune inhibitor use , intraoperative blood loss ),postoperative influential factors [days of ICU ,mechanical ventilation and ECMO support ,median value of Scr within one week after operation ,median tacrolimus concentration and the use of potential nephrotoxic drugs (≥4 kinds), hospitalization days] and survival rate one year after operation were observed in 2 groups. RESULTS :Within one week after lung transplantation,44 patients(68.8%)had experienced at least one episode of AKI ,among which 19 cases(29.7%)were stage 1, 17 cases(26.5%)were stage 2 and 8 cases(12.5%)were stage 3. The incidence of AKI was the highest on post-operative day 4 (57.4%). The incidence of AKI at stage 3 exhibited growth trend within the first week after operation ,and reached the highest on median post-operative day 5(8.7%). Operation duration ,median value of Scr within one week after operation ,median tacrolimus concentration in non-AKI group were significantly shorter or lower than AKI group ;there was no significant difference in operation type, ECMO support , use of immunosuppressive agents , intraoperative blood loss ,ICU days ,mechanical ventilation days,ECMO support days ,the utilization rate of potential nephrotoxic drugs ( ≥4 kinds) and hospitalization days between 2 groups (P>0.05). There was no statistical significance in the survival rate at stage 1 and 2 one year after operation between AKI group and non-AKI group (P>0.05). One year after operation ,survival rate of AKI group at stage 3 was significantly lower than that of non-AKI group (P<0.05). CONCLUSIONS:The incidence of AKI is high after lung transplantation. Operation duration ,median value of Scr within one week after operation ,median tacrolimus concentration were possible factors for the occurrence of AKI after operation.
期刊: 2020年第31卷第18期
作者: 杜雯雯,王晓星,陈文倩,张丹,刘慧芳,张相林,李朋梅
AUTHORS: DU Wenwen ,WANG Xiaoxing ,CHEN Wenqian ,ZHANG Dan,LIU Huifang ,ZHANG Xianglin ,LI Pengmei
关键字: 急性肾损伤;肺移植;术后;影响因素
KEYWORDS: Acute kidney injury ;Lung transplantation ;After operation ;Influential factors
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