肾功能不全患者行冠状动脉旁路移植术的长期随访结果  

Estimated glomerular giltration rate as a risk factor for long-term survival in Chinese renal insufficiency patients after isolated coronary artery bypass graft surgery

作　　者：林野[1] 郑哲[1] 胡盛寿[1] 许建屏[1] 吕锋[1] 王巍[1] 宋云虎[1] 孙寒松[1] 袁昕[1] 潘湘斌[1] 

机构地区：[1]中国医学科学院心血管病研究所阜外心血管病医院外科,北京100037

出　　处：《中华外科杂志》2010年第1期39-41,共3页Chinese Journal of Surgery

基　　金：基金项目：十一五国家科技支撑计划资助项目（2006BA101A09）;北京市科技计划资助项目（D0906004040391）

摘　　要：目的分析估测肾小球滤过率（eGFR）〈60ml／（min·1．73m2）的患者冠状动脉旁路移植术后的长期随访结果。方法回顾性分析1999年1月至2003年9月3371例冠状动脉旁路移植术患者的临床资料，用Cockcroft—Gauh公式计算eGFR，根据eGFR将患者分为肾功能不全组[eGFR〈60ml／（min·1．73m2），n=649]肾功能正常组[eGFR〉=60ml／（min·1．73m2），n=2722]，比较两组患者的近远期随访结果。结果肾功能不全组的住院病死率和随访4年病死率分别为2．77％和6．81％，明显高于肾功能正常组。肾功能不全组的其他围手术期并发症及远期不良事件发生率也明显高于肾功能正常组。多因素COX回归分析结果显示，eGFR〈60m]／（min·1．73m2）是冠状动脉旁路移植术后远期死亡的独立危险因素（HR=1．948，95％CI：1．357～2．797，P〈0．01）。结论eGFR〈60ml／（min·1．73m2）是冠状动脉旁路移植术的独立危险因素。Objective To investigate the eGFR as a risk factor for long-term （4-year） outcome in Chinese renal insufficiency patients after isolated coronary artery bypass grafting （CABG） at our institution. Methods From January 1999 to September 2003, 3371 consecutive patients who underwent isolated CABG were retrospectively reviewed. Of these patients, 549 （16. 29% ） patients were female, 1979 （58.71%） patients with hypertension, 866 （25.69%） patients with diabetes, 1130 （33.52%） patients with hyperlipidemia, 1011 （29.99%） patients with left main stenosis 〉 50%, and 1150 （34. 11%） patients undergoing off-pump procedures. The mean age was （60±9 ） years old. Estimated GFR was calculated using the Cockcroft-Gauh formula. The main outcomes were in-hospital mortality, in-hospital morbidity and long-term mortality. COX analysis was used in this study. Results There were 649 patients with glomerular filtration rate estimates 〈 60 ml/（ rain · 1.73 m2 ） and 2722 patients with glomerular filtration rate estimates 〉60 ml/（min· 1.73 m2）. The in-hospital mortality and follow-up mortality was higher in the estimated glomerular filtration rate 〈 60 ml/（ min · 1.73 m2 ） group （2. 77% vs. 0. 77%, P〈0. 01）, （6. 81% vs. 2. 63%, P〈0. 01）. The COX analysis result confirmed eGFR 〈60 ml/（min · 1.73 m2 ） , derived using the Cockcroft-Gault formula （ HR： 1. 948, 95% CI： 1. 357 to 2. 797, P 〈 0.01 ） was an independent risk factor for long-term mortality in patients after coronary artery bypass grafting surgery. Conclusions The estimated glomerular filtration rate 〈 60 ml/（ min · 1.73 m2 ） derived using the Cockcroft-Gauh formula is an independent risk factor for long-term mortality in patients after coronary artery bypass grafting surgery.

关 键 词：冠状动脉分流术 肾功能不全 肾小球滤过率 

分 类 号：R654.3[医药卫生—外科学] R692[医药卫生—临床医学]