冠状动脉旁路移植术后急性肾损伤影响因素探讨  

Investigations of influential factors of acute renal injury after coronary artery bypass grafting

作　　者：李西慧[1] 肖锋[1] 李岩[1] 王进[1] 宋波[1] 杨阳[1] 信维强[1] 杜迎利[1] 宋乃庆[1] 张明礼[1] 

机构地区：[1]北京大学第一医院心脏外科,北京100034

出　　处：《北京大学学报（医学版）》2009年第5期554-557,共4页Journal of Peking University:Health Sciences

摘　　要：目的:探讨急性肾损伤(acute kidney injury,AKI)在冠状动脉旁路移植(coronary artery bypass grafting,CABG)术后的发生率、相关影响因素以及对术后病情恢复的影响。方法:选择连续行择期CABG的68例患者为研究对象,根据急性肾损伤专家共识小组有关AKI的诊断标准,统计AKI在术后的发生率。以是否发生AKI把患者分为AKI组和对照组,对比分析两组间临床资料的差异。将差异有统计学意义的因素作为自变量进行Logistic退步法回归分析,寻找AKI的相关影响因素。结果:术后有27.94%(19/68)患者发生AKI,两组间比较显示性别、高血压、高血脂、移植血管桥数量、呼吸机使用时间、监护室停留时间、术后住院时间在两组间差异有统计学意义。Lo-gistic退步法多因素回归分析显示术前高血压(Wald3.27,P=0.07,95%CI0.85～53.59)、术中移植血管桥数量(Wald7.67,P=0.01,95%CI1.48～9.73)、呼吸机使用时间(Wald4.94,P=0.03,95%CI1.00～1.18)是术后AKI的危险因素。结论:CABG术后AKI有较高的发生率(27.94%),单因素分析显示女性、高血压、高血脂、术中移植血管桥数量、呼吸机使用时间是AKI的危险因素,而术后发生AKI可导致监护室停留时间和术后住院时间延长。Logistic退步法多因素回归分析提示高血压、移植血管桥数量以及呼吸机使用时间是AKI独立的危险因素。Objective： To investigate the incidence, correlate factors and effect on convalescent of acute kidney injury （AKI） after coronary artery bypass grafting （CABG）. Methods： Sixty-eight consecutive patients who underwent scheduled CABG were included. AKI was diagnosed according to the diagnostic criteria from expert group of AKI. The patients were divided into AKI group with AKI and control group without AKI. Difference of clinic features was contrasted between the two groups. And multivariable logistic regression modeling was used to identify the risk factors of AKI. Results： AKI occurred in 27.94% patients （19/68）. There was significant difference between the two groups in gender, hypertension, hiperlipemia, number of grafts, the duration of mechanic ventilation, the time of ICU and the length of stay post operation. Hypertension（ Wald 3.27, P =0. 07, 95% CI0. 85 -53.59）, number of grafts（ Wald 7.67, P = 0.01,95% CI 1.48 - 9.73）, the duration of mechanic ventilation（ Wald 4.94, P = 0. 03, 95 % CI 1.00 - 1.18 ） were risk factors of AKI in muhivariable logistic regression modeling. Conclusion： The incidence of AKI was high （27.94%）. Female, hypertension, hyperlipemia, number of grafts, the duration of mechanic ventilation were risk factors in monovariance analysis, and AKI may increase the time of ICU and the length of stay post operation. Hypertension, number of grafts, duration of mechanic ventilation were independent risk factors of AKI in muhivariable logistic regression model.

关 键 词：冠状动脉旁路移植术 非体外循环 肾功能衰竭 急性 危险因素 手术后并发症 

分 类 号：R654.1[医药卫生—外科学]