心脏手术后慢性病进展:一个回顾性多中心研究
Sune Bille1,2, Rasmus B Lindhardt1,2, Lars P Riber2,3
1Department of Anaesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark.
BJA open
|January 1, 2026
概括
经过心脏手术的慢性病 (CKD) 患者经历了显著的功能下降,特别是在出院后不久. 结构化的后续和干预措施对于管理高风险人群中CKD进展至关重要.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 心脏病学 心脏病学
- 公共卫生 公共卫生
背景情况:
- 慢性病 (CKD) 是心脏手术后不良结果的已知危险因素.
- 在心脏外科手术患者中,预先存在CKD的长期功能轨迹尚不清楚.
研究的目的:
- 描述心脏手术中患有先前存在的功能障碍的患者的CKD进展和功能衰竭.
- 评估预先存在的CKD和风险因素 (年龄,性别,术后急性损伤) 对心脏手术后CKD进展的影响.
主要方法:
- 成年心脏手术患者 (2000-2024) 的回顾性观察性多中心研究.
- 评估结果包括快速进展 (eGFR下降≥5毫升/分钟/1.73米2/年),CKD阶段进展 (eGFR下降≥25%随着阶段的推进) 和功能衰竭 (eGFR<15毫升/分钟/1.73米2).
- 竞争性风险分析在中位数为7年的随访期间占死亡率.
主要成果:
- 在27,483名患者中,3512名 (12.8%) 患有先前存在的CKD (KDIGO G3a-G5).
- 随着CKD的严重程度,五年生存率下降. 累计5年发生率为快速进展的38.7%,CKD阶段进展的23.8%,功能衰竭的5.5%.
- 事件集中在出院后的早期;男性70岁以下的G4阶段CKD和术后AKI的风险最高.
结论:
- 以前患有CKD的心脏手术患者面临着严重的病进展,特别是在出院后的早期.
- 研究结果强调了对这一群体进行结构化的后续计划和预防干预的必要性.
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