摘要
目的观察老年冠心病患者冠状动脉旁路移植术(coronary artery bypass grafting,CABG)后急性肾功能损伤(acute kidney injury,AKI)发生情况,探讨老年冠心病患者CABG术后发生AKI的危险因素。方法年龄≥65岁行CABG术的老年冠心病患者360例,根据术后48 h内是否发生AKI分为无AKI组251例和AKI组109例,比较2组围术期临床资料;采用多因素logistic回归分析老年冠心病患者CABG术后发生AKI的危险因素。结果AKI组体外循环时间[137.0(105.0,189.0)min]短于无AKI组[154.5(118.0,219.0)min](Z=-3.654,P<0.001),陈旧性心肌梗死史(39.4%)、同期行其他手术(23.9%)、术前左心室舒张末期内径≥55 mm(28.4%)、术前左室射血分数≤45%(31.2%)、体外循环(28.4%)、IABP植入(24.8%)、拔管后低氧血症(13.8%)比率均高于无AKI组(22.7%、13.9%、14.3%、10.4%、12.0%、9.2%、3.6%)(P<0.05),ICU停留时间[69.9(43.0,117.0)min]长于无AKI组[45.0(40.3,92.1)min](Z=-2.744,P=0.006);有陈旧性心肌梗死史(OR=1.810,95%CI:1.067~3.070,P=0.028)、IABP植入(OR=2.154,95%CI:1.010~4.592,P=0.047)、术前左室射血分数≤45%(OR=2.123,95%CI:1.050~4.294,P=0.036)及拔管后低氧血症(OR=3.165,95%CI:1.180~8.489,P=0.022)是老年冠心病患者CABG术后发生AKI的独立危险因素。结论陈旧性心肌梗死、IABP植入、术前左室射血分数≤45%、拔管后低氧血症是老年冠心病患者CABG术后发生AKI的危险因素;CABG术前积极调整合并有陈旧性心肌梗死或术前左室射血分数≤45%的老年患者心功能、避免拔管后低氧血症和IABP植入可降低术后AKI发生率。
Objective To observe the occurrence of acute kidney injury(AKI)after coronary artery bypass grafting(CABG),and to explore the risk factors of AKI after CABG in elderly patients with coronary heart disease.Methods Totally 360 patients with coronary heart disease and aged≥65 years old underwent CABG and were divided into no-AKI group(n=251)and AKI group(n=109)according to whether the patients had AKI in 48 h after operation.The perioperative clinical data were compared between two groups.Multivariate logistic regression was used to analyze the influencing factors of postoperative AKI.Results The duration of cardiopulmonary bypass was shorter in AKI group[137.0(105.0,189.0)min]than that in no-AKI group[154.5(118.0,219.0)min](Z=-3.654,P<0.001).The percentages of old myocardial infarction(39.4%),other surgery performed at same period(23.9%),preoperative left ventricular end-diastolic dimension≥55 mm(28.4%),preoperative left ventricular ejection fraction≤45%(31.2%),cardiopulmonary bypass(28.4%),intra-aortic balloon pump implantation(24.8%)and hypoxemia after extubation(13.8%)in AKI group were higher than those in no-AKI group(22.7%,13.9%,14.3%,10.4%,12.0%,9.2%,3.6%)(P<0.05),and the length of ICU stay was longer in AKI group[69.9(43.0,117.0)min]than that in no-AKI group[45.0(40.3,92.1)min](Z=-2.744,P=0.006).Old myocardial infarction(OR=1.810,95%CI:1.067-3.070,P=0.028),intra-aortic balloon pump implantation(OR=2.154,95%CI:1.010-4.592,P=0.047),preoperative left ventricular ejection fraction≤45%(OR=2.123,95%CI:1.050-4.294,P=0.036)and hypoxemia after extubation(OR=3.165,95%CI:1.180-8.489,P=0.022)were the independent risk factors of postoperative AKI in elderly patients with coronary heart disease.Conclusions Old myocardial infarction,intra-aortic balloon pump implantation,preoperative left ventricular ejection fraction≤45%and hypoxemia after extubation are the risk factors of postoperative AKI in elderly patients with coronary heart disease.To improve heart function of patients with old myocardial infarction or pr
作者
张华坤
孙俊杰
程兆云
胡俊龙
李传威
刘前进
赵勇
ZHANG Hua-kun;SUN Jun-jie;CHENG Zhao-yun;HU Jun-long;LI Chuan-wei;LIU Qian-jin;ZHAO Yong(Department of Cardiopulmonary Bypass,Henan Provincial People Hospital,Fuwai Central China Cardiovascular Hospital,Zhengzhou University Peopled Hospital,Zhengzhou,Henan 451464,China;Department of Cardiac Surgery,Henan Provincial People's Hospital,Fuwai Central China Cardiovascular Hospital,Zhengzhou University Peopled Hospital,Zhengzhou,Henan 451464,China)
出处
《中华实用诊断与治疗杂志》
2021年第12期1266-1269,共4页
Journal of Chinese Practical Diagnosis and Therapy
基金
国家自然科学基金(31970766)
河南省医学科技攻关计划项目(2018020456)
河南省医学科技攻关计划联合共建项目(2018020438)
河南省医学教育研究项目(Wjlx2020167)。
关键词
冠心病
冠状动脉旁路移植术
急性肾损伤
危险因素
coronary heart disease
coronary artery bypass grafting
acute kidney injury
risk factors
