体外及非体外循环冠状动脉旁路移植术后急性肾损伤的研究  

The research of acute kidney injury after coronary artery bypass surgery with or without pump

作　　者：裴锋博[1] 陈祖君[1] 刘平[1] 吴慧[1] 施野[1] 杜鹃[1] 李良[1] 

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外心血管病医院心血管疾病国家重点实验室, 北京100037

出　　处：《中华胸心血管外科杂志》2014年第4期228-230,237,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的 探讨体外及非体外循环两种冠状动脉旁路移植术式对患者术后急性肾损伤（AKI）的影响.方法 回顾性分析2011年3月至2013年1月阜外医院外科术后恢复室收治的824例冠状动脉旁路移植患者资料,根据手术方式分为体外循环组597例,非体外循环组227例.比较两组患者发生术后AKI情况.结果 体外循环组发生AKI 92例（占15.4％）,非体外循环组32例（占14.1％）,两组差异无统计意义,x2=0.222,P =0.638.术前基础肾功能下降的患者,术后AKI发生比例显著增高,差异有统计意义,P ＜0.05;中度肾功能不全患者,非体外循环组AKI发生比例低于体外循环组,P=0.02.两组患者肾脏替代的发生比例差异无统计意义.结论 体外与非体外循环冠状动脉旁路移植患者术后AKI发生比例差异无统计意义.对于术前基础肾功能下降的患者,非体外循环旁路移植术可降低患者术后AKI的发生,但不改变肾脏替代治疗的发生比例.Objective To study the impact of the off-pump coronary artery bypass compared to the on-pump coronary artery bypass technique on the rate of acute kidney injury.Methods A retrospective analysis of 824 patients accepted coronary artery bypass surgery in FuWai Hospital Surgical ICU from March 2011 to January 2013.Patients were divided into two groups according to the surgical approach,597 patients in on-pump group and 227 patients in off-pump group.Then compared the difference of acute kidney injury incidence in the two groups.Results 92 patients in the on-pump group occurred AKI,the incidence of AKI was 15.4%.32 patients in the off-pump group occurred AKI,the incidence of AKI was 14.1%.Two groups of patients had no statistical difference in the incidence of AKI,x2 =0.222,P =0.638.Based on the preoperative baseline creatinine clearance levels.We defined normal creatinine clearance （SCR ≥ 60 ml/min）,mild renal insufficiency （45 ml/min 〈 SCR 〈60 ml/min）,moderate renal dysfunction group（31 ml/min 〈 SCR 〈45 ml/min）.Decline with the preoperative creatinine clearance rate,the AKI incidence was elevated significantly,P 〈0.05.Patients with moderate renal insufficiency,offpump patients had lower incidence of AKI than those in on-pump group,P 〈 0.05.The incidence of renal replacement in the two group patients had no statistical differences.Conclusion The incidence of AKI after coronary artery bypass surgery had no statistical differences with or without pump.In the patients with preoperative moderate renal insufficiency,off-pump can reduce the incidence of AKI,but could not change the kidney the incidence of renal replacement treatment.

关 键 词：心肺转流术 冠状动脉旁路移植术 非体外循环 肾 损伤 

分 类 号：R654.2[医药卫生—外科学]