不停跳冠状动脉旁路移植术患者术后透析的危险因素分析  

Analysis of risk factors of postoperative hemodialysis in patients undergoing off-pump coronary artery bypass grafting

作　　者：董秀华[1] 卢家凯[1] 卿恩明[1] 王义军[1] 王成彬[1] 张亮[1] 刘玲[2] 

机构地区：[1]首都医科大学附属北京安贞医院麻醉科,100029 [2]首都医科大学附属北京安贞医院透析科,100029

出　　处：《中华医学杂志》2012年第19期1321-1324,共4页National Medical Journal of China

摘　　要：目的分析不停跳冠状动脉旁路移植术（OPCAB）患者术后透析的危险因素。方法回顾性分析首都医科大学附属北京安贞医院2007年11月至2009年2月2379例OPCAB患者围手术期资料，根据术后是否使用透析治疗分为透析组与非透析组。结果术后透析治疗54例，透析发生率为2．3％，透析组术后病死率为18．5％，非透析组术后病死率为0．9％。单因素分析表明，术中室颤、术中紧急中转体外循环、术前房颤、术中房颤、术前肾功能异常、术中使用大剂量肾上腺素、室壁瘤、合并瓣膜病、高血压、年龄以及搭桥支数与术后透析相关。多因素逻辑回归分析表明，术中室颤（OR=4．825，95％C11．696～13．730）、术中大剂量肾上腺素（OR=2．182，95％CI1．124—4．234）、高血压（OR=2．059，95％CI1．045～4．059）、年龄（OR=1．051，95％CI1．017～1．086）、搭桥支数（OR=0．578，95％C10．410～0．815）是术后透析的危险因素。结论术中室颤、术中大剂量肾上腺素、高血压、年龄、搭桥支数是术后透析的独立危险因素。Objective To investigate the risk factors of postoperative hemodialysis in patients undergoing off-pump coronary artery bypass grafting （OPCAB）. Methods The perioperative data of 2379 consecutive patients undergoing OPCAB from November 2007 to February 2009 were analyzed retrospectively. Patients were divided into dialysis group and non-dialysis group according to their use of hemodialysis therapy or not. Results Fifty-four patients experienced hemodialysis postoperatively. The incidence of hemodialysis was 2.3% , the mortality rate of dialysis group and non-dialysis group was 18.5% and 0. 9% respectively. Univariate analysis showed that these factors significantly related with the postoperative dialysis ：intraoperative ventricular fibrillation, emergent cardiopulmonary bypass, preoperative atrial fibrillation, intraoperative atrial fibrillation, preoperative renal dysfunction, intraoperative high-dose adrenaline usage, ventricnlar aneurism, combined valvular disease, hypertension, age and numbers of grafting vessels. Multivariate logistic regression showed that intraoperative ventricular fibrillation, intraoperative high-dose adrenaline usage, hypertension, age and the numbers of grafting vessel were the risk factors of postoperative hemodialysis for patients undergoing OPCAB surgery. Conclusion Intraoperative ventricular fibrillation, intraoperative high-dose adrenaline usage, hypertension, age and the numbers of grafting vessels were the independent predictors of postoperative hemodialysis in patients undergoing OPCAB surgery.

关 键 词：冠状动脉旁路移植术 非体外循环 血液透析 危险因素 

分 类 号：R654.2[医药卫生—外科学]