本文選題：心臟瓣膜手術 + 體外循環(huán)　； 參考：《浙江大學》2017年碩士論文

【摘要】：目的:回顧性分析成人體外循環(huán)下心臟瓣膜手術后急性腎損傷(acute kidney injury,AKI)的發(fā)病率及危險因素并初步建立中國心臟瓣膜手術后急性腎損傷的預測模型。方法:回顧性分析2010年1月-2015年12月1349例體外循環(huán)下心臟瓣膜手術患者的臨床資料,根據(jù)2012年KIDGO指南的臨床診斷標準,將其分為AKI組和非AKI組。統(tǒng)計術后AKI的發(fā)生情況,并進行單因素和多因素回歸分析心臟瓣膜術后AKI的發(fā)生率和危險因素。建立國人心臟瓣膜術后AKI預測模型;通過分辨力(受試者工作曲線下面積,AUROC)、校準度(Hosmer-lemeshow擬合優(yōu)度檢驗)驗證模型的預測價值。結果:1349例心臟瓣膜手術患者中有383例發(fā)生AKI,發(fā)生率為28.4%,多因素Logistic 回歸分析顯示,年齡(OR,1.05;P0.001)、糖尿病史(OR,2.11;P=0.008)、術前貧血(OR,1.50;P=0.026)、術前肌酐水平(OR,1.01;P=0.001)、手術時間(OR,1.28;P0.001)、術中輸注血漿(OR,1.50;P=0.004)是心臟瓣膜術后發(fā)生AKI的獨立危險因素,ROC曲線下面積是0.729,提示根據(jù)危險因素建立的模型的分辨力和校準度均較好。結論:體外循環(huán)下心臟瓣膜術后AKI的獨立危險因素是高齡、糖尿病史、術前貧血、術前肌酐高、手術時間長以及術中輸注血漿。
[Abstract]:Objective: to retrospectively analyze the incidence and risk factors of acute renal injury (acute kidney injuryaki) after cardiac valve surgery in adults under cardiopulmonary bypass (CPB) and to establish a predictive model of acute renal injury after cardiac valve surgery in China. Methods: the clinical data of 1349 patients undergoing cardiac valve surgery under cardiopulmonary bypass from January 2010 to December 2015 were retrospectively analyzed and divided into AKI group and non-AKI group according to the clinical diagnostic criteria of KIDGO guidelines in 2012. The incidence and risk factors of AKI after cardiac valve operation were analyzed by univariate and multivariate regression analysis. The prediction model of AKI after cardiac valve surgery in Chinese was established, and the predictive value of the model was verified by resolution (area under the operating curve) and Hosmer-lemeshow goodness of fit test. Results 383 of 1349 patients with heart valve surgery had AKI, the incidence rate was 28.4.The multivariate logistic regression analysis showed that, Age (OR1. 05 / P0.001), history of diabetes (OR2. 11 / P0. 008), preoperative anemia (OR1. 50 / P0. 026), preoperative creatinine level (OR1. 01 / P0. 001), time of operation (OR1. 28 / P0. 001), intraoperative infusion of plasma (OR1. 50 P0. 004) were independent risk factors for AKI after heart valve surgery. The area under the ROC curve was 0. 729, suggesting that the model based on risk factors was established. The resolution and calibration are good. Conclusion: the independent risk factors for AKI after cardiac valve surgery under cardiopulmonary bypass are old age, history of diabetes, preoperative anemia, high preoperative creatinine, long operation time and intraoperative infusion of plasma.
【學位授予單位】：浙江大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R654.2
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本文編號：2089242