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首页> 外文期刊>Journal of cardiac surgery. >Valve replacement surgery complicated by acute renal failure-predictors of early mortality.
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Valve replacement surgery complicated by acute renal failure-predictors of early mortality.

机译：瓣膜置换手术并发急性肾衰竭的早期死亡预测因素。

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Background: Acute renal failure (ARF) is a serious complication of valve replacement surgery. The aim of this study was to determine the predictors of early mortality and if causative factors are preventable. Methods: In the 25-year period between 1977 and 2002, 255 (2.6%) of 9721 patients (11,007 operations), who had valve replacement surgery, were managed for ARF with dialysis. The mean age of the patient population was 67.1 +/- 11.6 years (range 24 to 87 years, median 70.3 years). Fifty preoperative, operative, and postoperative risk factors were assessed as predictors of early mortality by univariate and multivariate modeling. Results: The early mortality was 25.1% (64 patients). The predictors by univariate analysis were: New York Heart Association class (p = 0.001); ASA within 5 days (p = 0.030); cardiogenic shock (p = 0.010); infection-perioperative sepsis and preoperative endocarditis (p = 0.000); intraoperative stroke (p = 0.003); status-emergent (p = 0.000); mitral valve replacement (p = 0.040); ischemic (X-clamp) time >120 minutes (p = 0.020); cardiopulmonary bypass time >180 minutes (p = 0.000); surgical time >360 minutes (p = 0.000); surgical hemorrhage (p = 0.020); acute respiratory distress syndrome (ARDS) (p = 0.040). Multivariate predictors were urgent status of operation, odds ratio (OR) 0.3 (p = 0.029); emergent status of operation, OR 5.8 (p = 0.034); ischemic (X-clamp) time >120 minutes, OR 4.4 (p = 0.030); surgical time >360 minutes, OR 6.3 (p = 0.019); surgical hemorrhage, OR 5.1 (p = 0.003); perioperative nosocomial sepsis, OR 3.8 (p = 0.006); and preoperative endocarditis, OR 4.4 (p = 0.004). Conclusions: Early mortality from ARF in valve replacement surgery is related to emergent status, ischemic and surgical times, surgical hemorrhage, and nosocomial infection/preoperative endocarditis. Among the variables assessed, preoperative renal insufficiency, unstable angina/recent myocardial infarction <6 weeks, and concomitant coronary artery bypass were not predictive. The evaluation of predictors of ARF requires further extensive assessment.
机译：背景：急性肾衰竭（ARF）是瓣膜置换手术的严重并发症。这项研究的目的是确定早期死亡率的预测因素，以及是否可以预防因果关系。方法：在1977年至2002年的25年中，对接受瓣膜置换手术的9721例患者（11,007例手术）中的255例（2.6％）进行了透析治疗。患者人群的平均年龄为67.1 +/- 11.6岁（范围为24至87岁，中位数为70.3岁）。通过单变量和多变量模型将五十种术前，术中和术后危险因素评估为早期死亡率的预测指标。结果：早期死亡率为25.1％（64例患者）。单因素分析的预测因子为：纽约心脏协会分类（p = 0.001）; 5天之内的ASA（p = 0.030）;心源性休克（p = 0.010）;感染-围手术期败血症和术前心内膜炎（p = 0.000）;术中卒中（p = 0.003）;紧急状态（p = 0.000）;二尖瓣置换术（p = 0.040）;缺血（X钳）时间> 120分钟（p = 0.020）;心肺旁路时间> 180分钟（p = 0.000）;手术时间> 360分钟（p = 0.000）;手术出血（p = 0.020）;急性呼吸窘迫综合征（ARDS）（p = 0.040）。多变量预测指标为紧急手术状态，优势比（OR）为0.3（p = 0.029）;操作紧急状态，或5.8（p = 0.034）;缺血（X夹）时间> 120分钟，或4.4（p = 0.030）;手术时间> 360分钟，或6.3（p = 0.019）;手术出血，OR 5.1（p = 0.003）;围手术期医院败血症，OR 3.8（p = 0.006）;和术前心内膜炎，或4.4（p = 0.004）。结论：瓣膜置换术中ARF的早期死亡率与急诊状态，缺血和手术时间，手术出血以及医院感染/术前心内膜炎有关。在评估的变量中，术前肾功能不全，不稳定型心绞痛/最近的心肌梗塞<6周以及伴随的冠状动脉搭桥术不能预测。对ARF预测因子的评估需要进一步的广泛评估。

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