摘要
目的对比研究体外循环冠状动脉旁路移植术(CCABG)和非体外循环冠状动脉旁路移植术(OPCABG)对术后急性肾损伤(AKI)发生的影响,并分析CABG术后AK1的危险因素。方法回顾性分析2009年1月至2017年12月3346例接受单纯CABG患者资料,按照是否运用体外循环分为CCABG组(2275例)和OPCABG组(1071例)。收集可能与AK1发生相关的临床资料作为变量,比较CCABG组和OPCABG组术后发生AKI的差异,采用logistic回归法分析发生AKI的独立危险因素。剔除术前接受肾脏替代治疗、肌酐值记录缺失、急诊手术及合并其他手术的病例。结果全组术后共发生AKI603例,其中CCABG组427例(1&8%),OPCABG组176例(16.4%),两组间差异无统计学意义(F=2.53,P=0.11)。住院期间新发肾衰透析47例,其中CCABG组35例(1.5%),OPCABG组12例(1.1%),两组间差异无统计学意义(X^2=0.64,P=0.42)。较未发生AKI的患者,术后发生AKI患者的机械通气[(33.1±17.5)h对(16.4±10.7)h]JCU住院[(37.5±16.8)h对(2.8±9.5)h]、术后普通病房住院[(18.1±6.3)天对(10.3±3.7)天]均显著延长,差异均有统计学意义(P<0.01)。多因素回归分析结果显示,高血压病史、术前肾功能不全、体外循环、低心排血量综合征、围手术期应用主动脉内球囊反搏(1ABP)、输血和术后3天内体温超过38七是CABG术后发生AKI的独立危险因素。结论CABG术后发生AKI常见,相较于CCABG,OPCABG并不能显著降低术后AKI和新发肾衰透析的发生比例。高血压病史、术前肾功能不全、低心排血量综合征、围手术期应用IABP、大量输血和术后3天内体温超过38T是CABG术后AK1的独立危险因素。
Objective To compare the impact of cardiopulmonary coronaiy artery bypass grafting ( CCABG ) and offpump coronaiy artery bypass grafting ( OPCABG) on the incidence of acute kidney injury (AKI), and assess the independent risk fat tors of AKI. Methods Data of the isolated CABG patients in our center from January 2009 to December 2017 were collected and analyzed. 3 346 patients entered the study, including 2 275 in CCABG group and 1 071 in OPCABG group. To compare the impact of CCABG and OPCABG on the incidence of AKI,and to assess the independent risk factors of AKI after CABG by the logistics regression method. The following were exclude: patients with long-term dialysis, patients with missing serum creatinine data, emergenl cases and CABG combined with other cardiac procedures. Results AKI occurred in 427 patients in CCABG group(18. 8%) and 176 patients in OPCABG group( 16. 4%), there were no differences(X^2 = 2. 53 ,P= 0. 11 ).There were no differences of new onset of dialysis between CCABG group( 35 cases, 1.5%) and OPCABG group( 12 cases, 1. 1 %),x^2= 0. 64, P =0.42. Comparing wilh patients without AKI, those with AKI had a longer mechanical ventilation support time [(33. 1 ± 17. 5) h vs.(16.4 ± 10. 7) h], 1CU time[(37. 5 ± 16. 8) h vs.(2.8 ± 9. 5 ) h ] and ward lime[(18.1 ±6.3) days vs.( 10. 3 ± 3. 7) days], all P <0. 01. Logistic regression analysis modeling showed hypertension, preoperalive renal dysfunc tion, duration of cardiopulmonary bypass, low cardiac output syndrome, perioperative application of intra-aorlic ballon pump( IABP), blood transfusion and postoperative body temperature above 38T within 3 days were independent risk factors of AKI. Conclusion AKI is a common complication after CABG. Comparing to CCABG, OPCABG is not associated with a significant low rate of AKI or dialysis. Hypertension , preoperative renal dysfunction , low cardiac output syndrome, perioperative application of IABP, blood transfusion and postoperative body lemprrature above 38℃ within 3 days were independent risk f
作者
王睿
朱一帆
陈文
景启明
陈鑫
Wang Rui;Zhu Yifan;Chen Wen;Jing Qiming;Chen Xin(Department of Cardiovascular Surgery, Nanjing Hospital Affiliated to Nanjing Medical University, Nanjing First Hospital, Nanjing Cardiovascular Hospital, Xdnjing 210006 , China)
出处
《中华胸心血管外科杂志》
CSCD
北大核心
2019年第3期167-170,共4页
Chinese Journal of Thoracic and Cardiovascular Surgery
基金
江苏省科技厅社会发展项目(BE2015612)
南京市医学科技发展项目(YKK14080).
关键词
冠状动脉旁路移植
急性肾损伤
危险因素
Coronary artery bypass grafting
Acute kidney injuiy
Risk factors
