摘要
目的探讨非体外循环下冠状动脉旁路移植术（off-pump coronary artery bypass grafting,OPCABG）后发生急性肾损伤（acute kidney injury,AKI）的危险因素。方法回顾性分析2013年1月~2015年2月我院156例择期OPCABG的临床资料,根据急性肾损伤网络小组（acute kidney injury network,AKIN）的AKI诊断标准,将患者分成2组：AKI组（n=54）及非AKI组（n=102）,对2组患者术前、术中及术后可能与发生AKI有关的变量进行单因素分析,有差异的变量进行logistic回归分析,筛选出OPCABG后发生AKI的危险因素。结果 OPCABG术后AKI发生率为34.6%（54/156）,其中2例行透析治疗,后均因急性心功能衰竭死亡。单因素分析显示：年龄〉70岁、高血压病史、糖尿病史、糖化血清蛋白值、术前BNP、术后BNP、术前血肌酐、术前LVEF（左室射血分数）〈40%、室间隔厚度、术中输注悬浮红细胞及血浆量、ICU停留时间、机械通气时间、术后住院时间差异具有统计学意义（P〈0.05）。logistics回归分析显示：年龄〉70岁（OR=4.988,95%CI：1.098~22.649,P=0.043）,高血压病史（OR=3.323,95%CI：2.718~8.582,P=0.026）,糖尿病史（OR=2.004,95%CI：1.277~3.145,P=0.019）,糖化血清蛋白（OR=1.716,95%CI：0.646~4.710,P=0.016）,术前血肌酐（OR=7.149,95%CI：6.969~7.334,P=0.023）,术前LVEF〈40%（OR=12.138,95%CI：7.448~19.846,P=0.008）,术中输注悬浮红细胞（OR=1.891,95%CI：1.283~2.787,P=0.007）,术中输注血浆量（OR=1.491,95%CI：1.374~1.652,P=0.039）,机械通气时间（OR=2.665,95%CI：2.608~2.723,P=0.008）为OPCABG术后发生AKI的危险因素。结论 AKI的发生与多种围手术期危险因素有关,应充分重视这些危险因素的评估。
Objective To investigate influence factors of acute kidney injury（ AKI） after off-pump coronary artery bypass grafting（ OPCABG）. Methods Clincal data of 156 patients who received OPCABG in our center between January 2013 to February2015 were retrospectively analyzed. The 156 cases were divided into two groups according to the AKIN（ Acute Kidney Injury Network）recommended criteria of AKI： those who developed AKI（ AKI group,n = 54） and those who did not develop AKI（ non-AKI group,n = 102）. The difference between the two groups was analyzed,and then the logistic regression analysis was used to identify the influence factors of AKI after OPCABG. Results The incidence of AKI after OPCABG was 34. 6%（ 54 /156）. Two of them needed a dialysis and died of acute heart failure. Univariate analysis showed statistical significance between the two groups in age more than 70 years old,hypertension,diabetes,glycated serum protein（ GSP）,preoperative and postoperative BNP,preoperative serum creatinine（ Sc）,preoperative left ventricle ejection fraction（ LVEF） 〈 40%,thickness of interventricular septum,amount of blood transfusion,ICU staying,mechnical ventilation time,and postoperative hospital stay（ P 〈 0. 05）. Logistic regression analysis indicated that age more than 70 years old（ OR = 4. 988,95% CI： 1. 098- 22. 649,P = 0. 043）,hypertension（ OR = 3. 323,95% CI： 2. 718- 8. 582,P = 0. 026）,diabetes（ OR = 2. 004,95% CI： 1. 277- 3. 145,P = 0. 019）,preoperative Sc（ OR = 7. 149,95% CI： 6. 969-7. 334,P = 0. 023）,preoperative LVEF 40%（ OR = 12. 138,95% CI： 7. 448- 19. 846,P = 0. 008）,amount of red blood cell transfusion（ OR = 1. 891,95% CI： 1. 283- 2. 787,P = 0. 007）,amount of blood plasma transfusion（ OR = 1. 491,95% CI：1. 374- 1. 652,P = 0. 039）,and mechnical ventilation time（ OR = 2. 665,95% CI： 2. 608- 2. 723,P = 0. 008） were risk factors of development of AKI after OPCABG. Conclusion Development of AKI after OPCABG is related to various risk
出处
《中国微创外科杂志》
CSCD
北大核心
2016年第3期197-200,共4页
Chinese Journal of Minimally Invasive Surgery
