体外循环与非体外循环下冠状动脉旁路移植术后肾损害  

Incidence and risk factors of acute kidney injury post off.pump and on-pump coronary artery bypass grafting

作　　者：谷天祥[1] 张文峰[1] 修宗谊[1] 房勤[1] 张玉海[1] 王春[1] 

机构地区：[1]中国医科大学附属第一医院心脏外科,沈阳110001

出　　处：《中华心血管病杂志》2008年第12期1092-1096,共5页Chinese Journal of Cardiology

基　　金：辽宁省教育厅高等学校科学研究项目（2004C050）

摘　　要：目的探讨体外循环下冠状动脉旁路移植术（CCAB）与非体外循环下冠状动脉旁路移植术（OPCAB）后1周内肾损害及其变化规律。方法我们对自1990年1月至2006年8月间849例单纯行冠状动脉旁路移植术的病例进行回顾性分析。采用logistic回归模型分析急性肾损害的风险因素。血清肌酐（Scr）130～199μmol／L或矫正的肌酐清除率30—60ml·min^-1·1．73m^-2作为急性肾损害（AKI）的诊断标准。结果518例OPCAB发生AKI 61例，331例CCAB发生AKI 63例。AKI的风险因素包括：左心室射血分数（LVEF）〉50％、LVEF〈30％、脉压≥60mmHg（1mmHg=0．133kPa）、外周血管疾病、糖尿病、急诊手术、3支病变、体质指数、术中及术后使用主动脉球囊反搏（IABP）、心功能分级、体外循环。其中LVEF〉50％、术中及术后使用IABP可能是保护因素（OR〈1）。术后发生肾损害患者的Scr峰值OPCAB组为术后12h，CCAB组为术后24h；Scr快速恢复期OPCAB组为术后24～48h，CCAB组为术后48～72h。结论AKI预防及治疗的关键期为自麻醉至OPCAB后48h或CCAB后72h。Objective To investigate the incidence and risk factors of acute kidney injury （AKI） within the first postoperative week after off-pump or on-pump coronary artery bypass （ OPCAB or CCAB） surgery. Methods Consecutive patients underwent CABG between January 1990 and August 2006 in our institution and had normal serum creatinine （Scr） and estimated creatinine clearance （Ccr） values before operation were retrospectively analyzed. Multivariate logistic regression analysis was performed to identify risk factors for the development of AKI defined as Scr 130 -199μmol/L or Ccr 30 -60 ml· min^-1 · 1.73 m^-2 Results Incidence of AKI was significantly higher in patients underwent CCAB compared to those underwent OPCAB （63/331 vs. 61/518, P 〈 0. 01 ）. Peak Scr value was seen at 12th hour post OPCAB and 24th hour post CCAB, respectively. The rapid recovering of Scr occurred between 24th hour to 48th hour in patients underwent OPCAB and 48th hour to 72th hour in patients underwent CCAB surgery. Multivariate forward stepwise logistic regression analysis showed that LVEF 〈 30%, pulse pressure ≥ 60 mm Hg （ 1 mm Hg =0. 133 kPa）, peripheral vascular disease, diabetes, emergent procedure, triple-vessel disease, higher body mass index （kg/m^2）, intraoperative and postoperative IABP, NYHA class Ⅲ or Ⅳ and cardiopulmonary bypass were risk factors for the development of postoperative AKI following CABG, while LVEF 〉 50% and intraoperative and postoperative IABP were associated with lower incidence of AKI （ OR 〈 1 ）. Conclusion AKI is not a rare complication post OPCAB or CCAB surgery, especially in patients with reduced LVEF, increased pulse pressure, peripheral vascular disease, diabetes, emergent procedure, triplevessel disease, higher body mass index, intraoperative and postoperative IABP.

关 键 词：冠状动脉旁路移植术 危险眭评估 体外循环 临床分析 

分 类 号：R686[医药卫生—骨科学]