目的 探究急性 Stanford A 型主动脉夹层术后行连续肾脏替代疗法（CRRT）的独立危险因素 及预防策略。方法 回顾性分析南方医科大学珠江医院 2020 年 9 月至 2021 年 12 月收治的急性 Stanford A 型主动脉夹层患者 115 例（男/女为 93/22），年龄（53.16 ± 11.43）岁；根据术后是否行 CRRT 将术后患者分为 CRRT 组（n = 23），非 CRRT 组（n = 92），采用单因素分析得出危险因素并纳入多因素 logistic 回归以明确独 立危险因素。结果 围术期死亡 19 例（16.88%），其中 CRRT 组死亡 9 例，非 CRRT 组死亡 10 例，两组死亡 率差异有统计学意义（χ2 = 10.655，P = 0.001）。CRRT 组与非CRRT组单因素分析提示术前肌酐、术前夹层 累及肾动脉、阻断时间、体外循环时间、手术时间、术中输红细胞量、术中输血浆量与急性Stanford A 型主动 脉夹层术后行 CRRT 有关，而经 logistic 回归分析进一步明确术前肌酐（OR = 1.875，P = 0.014）、阻断时间 （OR = 1.874，P = 0.008）、手术时间（OR = 1.014，P = 0.012）、术中输红细胞量（OR = 2.183，P = 0.017）为急性 Stanford A 型主动脉夹层术后行 CRRT 的独立危险因素。ROC 曲线分析得出，术前肌酐在预测急性 Stan⁃ ford A 型主动脉夹层术后行 CRRT 的效能最高。结论 术前肌酐、阻断时间、体外循环时间和术中输红细 胞量是急性 Stanford A 型主动脉夹层术后行 CRRT 的独立危险因素；围手术期对患者实施有效评估和对应 措施，可降低急性Stanford A 型主动脉夹层术后行CRRT 的风险。

Objective The aim of this study was to analyzed the CRRT factors of acute Stanford type A aortic dissection surgery retrospectively and identify the risk factors for CRRT after acute Stanford type A aortic dissection surgery. Methods 115 patients（93 males and 22 females，at a mean age of（53.16 ± 11.43）years with acute Stanford type A aortic dissection at the cardiovascular surgery department of our hospital from September 2020 to December 2021）were collected and retrospectively analyzed. 23 patients were acute kidney injury after re⁃ ceive acute Stanford type A aortic dissection surgery were assigned into the CRRT group，and the remaining pa⁃ tients（n = 92）were included in the non⁃CRRT group. The perioperative data were reviewed and the risk factors were identified by univariate analysis，which further confirmed by logistic regression. Results There were 19 pa⁃ tients dead during perioperative period in our study. There were 9 deaths in the CRRT group and 10 deaths in the non⁃CRRT group. The mortality of the two groups was statistically significant（χ2 = 10.655，P = 0.001）. Univariate analysis identified Preoperative creatinine，block time，extracorporeal circulation time，operation time，intraopera⁃ tive red blood cell volume，intraoperative plasma volume were risk factors for CRRT after acute Stanford type A aor⁃ tic dissection surgery. Logistic regression analysis further identified preoperative creatinine （OR = 1.875，P = 0.014），blocking time（OR = 1.874，P = 0.008），time of operation（OR = 1.014，P = 0.012）and intraoperative erythrocyte transfusion（OR = 2.183，P = 0.017）were independent risk factors for CRRT after acute Stanford type A aortic dissection surgery. The receiver operating characteristic（ROC）curve analysis showed that preoperative creatinine was the most effective in predicting postoperative CRRT of acute Stanford type A aortic dissection.Conclusion It was confirmed that preoperative creatinine，block time，CPB time and intraoperative red blood cell volume were independent risk factors for CRRT after acute Stanford Type A aortic dissection. Effective perioperative assessment and management of patients can reduce the risk of CRRT after acute Stanford type A aortic dissection.