| Objective:The main causes of diseases related to aortic dissection are hypertension and diseases in the middle layer of aorta.In recent years,the number of cases is increasing day by day,and its high mortality rate seriously threatens the life safety of patients.At present,Thoracic Endovascular Aortic Repair(TEVAR)was adopted to the surgical treatment of Sanford B type aortic dissection in our country.However,surgical complications often occur in patients after Thoracic Endovascular Aortic Repair.This study mainly discusses the related risk factors and prognosis of Acute Kidney Injury(AKI)in Stanford B type aortic dissection patients after TEVAR.It is hoped that the results can guide the early prevention and identification of high-risk groups with AKI after TEVAR.So as to reduce the risk of AKI after operation and improve the prognosis of many patients.Methods:The data of complete disease history and relevant statistics from December2013 to December 2016 in An Hui province hospital are selected as the research object.The patients who have been diagnosed as Stanford type-B aortic dissection by Computer tomography angiography(CTA)and underwent TEVAR are selected as the research object.Various indicators of renal function of patients before and within 48 h after operation and diagnose acute kidney injury according to the Acute Kidney Injury Network(AKIN)were collected.The patients were divided into AKI group and non-AKI group.The medical history and clinical data of the two groups of patients were analyzed retrospectively.The patients were followed-up by telephone and out-patientfollow-up.The main observation indicators are the patients’ recent mortality and causes of death,and whether there is any difference in the recent prognosis between the two groups is compared.Results:According to the exclusion criteria,there are 193 patients.They are 157 males and 36 females.There are 138(71.50 %)cases of hypertension,16(8.30 %)cases of diabetes and 65(33.68%)cases of smoking history.36 cases(18.7%)have acute kidney injury after TEVAR.Univariate analysis indicated that the history of diabetes,systolic blood pressure at admission,diastolic blood pressure at admission,dose of contrast agent administered during operation and scope of involvement of the renal artery were significantly related to post-TEVAR acute kidney injury(all P<0.05).Multivariate Logsitic regression analysis demonstrated that the history of diabetes(OR=4.458,95%CI=1.176–16.897,P=0.028),systolic pressure at admission(OR=1.036,95% CI=1.011– 1.063,P<0.01);dose of contrast agent administered during operation(OR=1.025,95% CI=1.012-1.038,P<0.01);renal artery involvement(OR=3.130,95%CI=1.222-8.017,P=0.017)were independent risk factors for post-TEVAR acute kidney injury.In the acute kidney injury group,31 cases are followed up and 5 cases are lost.In the non-acute kidney injury group,142 cases are followed up and 11 cases are missed.The overall miss rate is 8.30%.The average follow-up time is 18.3 months.Analysis of follow-up results has showed that the early mortality rate of patients with acute kidney injury is significantly higher than patients with non-acute kidney injury patients(22.6%vs.6.3%,χ2=8.00,P<0.005).Cox regression analysis has shown that the postoperative survival rate of patients with a history of diabetes is significantly lower than that of patients without a history of diabetes(OR=20.08,P<0.05).Conclusion:At present,the risk factors for AKI after TEVAR are not unified.The results of this study show that the level of the admission systolic pressure,the history of diabetes,dose of contrast agent used and involvement of bilateral renal arteries areclosely related to acute kidney injury in Stanford B-type aortic dissection patients after TEVAR.The early mortality rate of patients with acute kidney injury after TEVAR is significantly increasing and the history of diabetes has predictive value for the prognosis of patients after TEVAR. |
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