A Study On Acute Kidney Injury After Stanford Type A Aortic Dissection

ObjectivesTo analyze the influencing factors of continuous renal replacement therapy(CRRT)in patients with acute renal injury(AKI)after aortic Stanford type A dissection.MethodsThe clinical data of 1 378 Stanford type A aortic dissection patients who underwent surgical treatment in our center from January 2010 to December 2017 were retrospectively collected.The surgical method was selected according to the extent of dissection involved and the characteristics of aortic root lesions.Patients were divided into non-CRRT group(n=1 263)and CRRT group(n=115)based on whether CRRT was performed after surgery.Statistical analysis of the perioperative and operative factors of the two groups were collected and performed.ResultsThe incidence of CRRT was 8.3%(115/1378).There were 91(6.6%)early mortality,and 47(41.6%)deaths in the CRRT group and 44(3.7%)deaths in the non-CRRT group.the mortality rate in the CRRT group was 11.2 times that in the non-CRRT group(P<0.001).Logistics multivariate regression analysis showed that patients with senior age,preoperative liver damage,high volume of RBC transfusion are independent risk factors for severe AKI requiring CRRT treatment.ConclusionsIt is feasible to use Logistic regression model to establish a risk assessment system for predicting postoperative acute renal injury in patients with Stanford type A aortic dissection.patients with senior age,preoperative liver damage,high volume of RBC transfusion are independent risk factors for postoperative CRRT.Those factors should be priorly considered for the purpose of renal function protection and AKI prevention.ObjectivesTo analyze whether there is a difference in renal function in patients with different renal artery involvement types by aortic CTA observation,and try to explore a relatively simple theoretical prediction model for predicting renal damage after Stanford A-type aortic dissection by aortic CTA examinationMethodsData were collected from January 2010 to December 2017 and included 1331 patients with Stanford type A aortic dissection who underwent surgery at our center.According to the aortic CT plane scan,the anatomical involvement of one side of the renal artery can be divided into the following 5 cases:type T(True lumen involved),type F(False lumen involved),type B(Both lumens involved),type C(Crushed intimal flap),type S(Sandwich model).According to the actual CT tomographic observation statistics,bilateral renal artery involvement can be divided into TT type(n=575),TF type(n=352),TB type(n=198),and BB type(n=17),BF type(n=30),CF type(n=84),TS type(n=75).The incidences of postoperative AKI and CRRT and the early postoperative mortality of patients with bilateral renal artery involvement were analyzed and compared.ResultsThe analysis results showed that the incidences of AKI after TT,TF,TB,BB,BF,CF,and TS were 14.61%(84/575)?22.44%(79/352)?36.36%(72/198)?52.94%(9/17)?40.0%(12/30)?65.48%(55/84)?36.0%(27/75),the incidence of postoperative CRRT treatment was 3.48%(20/575)?6.82%(24/352)?12.12%(24/198)?17.65%(3/17)?10.00%(3/30)?32.14%(27/84)?9.33%(7/75),and early mortality was 4.17%(24/575)?4.26%(15/352)?11.11%(22/198)?11.76%(2/17)?13.33%(4/30)?17.86%(15/84)?5.33%(4/75).ConclusionsIt is feasible to establish an anatomical model of renal artery damage that predicts acute renal insufficiency in patients with Stanford type A aortic dissection after aortic CTA examination.From the statistical results,it can be seen that the incidence of postoperative AKI,CRRT treatment,and early postoperative mortality in the CF and BB groups were significantly higher than those in the other groups.Stanford type A aortic dissection renal artery involvement anatomy typing has certain predictive effect on renal function and prognosis.