重度肾功能损害患者行不停跳冠脉搭桥术后持续肾脏替代治疗影响因素分析  

Risk factors of continuous renal replacement therapy in patients with preoperative severe renal injury undergoing off-pump coronary artery bypass grafting

作　　者：刘金金[1] 王岳锋[1] 马月华[1] 金沐[1] 

机构地区：[1]首都医科大学附属北京安贞医院北京市心肺血管疾病研究所麻醉中心,100029

出　　处：《临床麻醉学杂志》2017年第7期675-679,共5页Journal of Clinical Anesthesiology

摘　　要：目的探讨重度肾功能损害患者行非体外循环冠状动脉旁路移植术(off-pump coronary artery bypass grafting,OPCABG)术后应用持续肾脏替代治疗(continuous renal replacement therapy,CRRT)的术前独立危险因素。方法访问首都医科大学附属北京安贞医院麻醉科OPCABG围术期数据库,收集2012年2月至2016年7月术前血清肌酐(Cr)重度升高(血清Cr值≥正常值1.5倍)患者行OPCABG的临床资料,统计术后CRRT发生情况,采用Logistic回归分析CRRT的术前独立危险因素。结果共纳入45例患者,术后应用CRRT有9例(20%)。与非CRRT患者比较,CRRT患者术前血清Cr和尿素氮(BUN)浓度明显升高,术中尿量明显减少,术后12、24h血清Cr浓度明显升高,术后ICU时间明显延长,院内死亡率明显升高(P<0.05或P<0.01)。Logistic回归分析显示,术前血清Cr浓度升高为术后CRRT的独立危险因素(OR=1.05,95%CI 1.05~1.10,P=0.046)。当术后12h血清Cr浓度>166μmol/L时,每升高1μmol/L,术后CRRT治疗率增加5%(OR=1.05,95%CI 1.01~1.08,P=0.013),但在血清Cr浓度>350μmol/L时,达到封顶效应。结论术前血清Cr重度升高患者OPCABG术后CRRT治疗率为20%,而术前血清Cr浓度升高是OPCABG患者术后CRRT的独立危险因素。Objective To analyze risk factors of continuous renal replacement therapy（CRRT）in patients with severe serum creatinine levels elevation undergoing off-pump coronary artery bypass grafting（OPCABG）.Methods The perioperative data of 45 patients with severe elevation of preoperative serum creatinine levels undergoing OPCABG were investigated based on the perioperative CABG database from Feb,2012 to Jul,2016.The postoperative treatment rates of CRRT were recorded and the risk factors were identified by multivariate logistic regressions.Results There were 9patients（20%）who suffered from CRRT after OPCABG in all 45 recruitment patients.Compared with non-CRRT patients,there were higher levels of serum creatinine（Cr）and blood urea nitrogen（BUN）before surgery,a lower volume of urine during surgery,a higher level of serum creatinine at postoperative 12 hour and 24 hour,longer ICU staying time and higher in-hospital mortality after surgery in patients with CRRT（P〈0.05 or P〈0.01）.Multivariate logistic regression analysis demonstrated that preoperative level of serum creatinine（OR=1.05,95% CI 1.05-1.10,P=0.046）was the independent risk factor of postoperative CRRT in patients with severe serum creatinine levels elevation undergoing OPCABG.At the value of postoperative 12 hour serum creatinine up to 166μmol/L,the incidence of postoperative CRRT in patients increased 5% by postoperative 12 hour serum creatinine increasing 1μmol/L（OR=1.05,95% CI 1.01-1.08,P=0.013）.However at the value of postoperative 12 hour serum creatinine above 350μmol/L,＂ceiling effect＂was apparent.Conclusion This study shows that 20% patients with preoperative severe serum creatinine level elevation are suffered from CRRT after OPCABG procedure and preoperative level of serum creatinine is predominant factor of postoperative CRRT.

关 键 词：非体外循环冠状动脉旁路移植术 血清肌酐 持续肾脏替代治疗 危险因素 

分 类 号：R654.2[医药卫生—外科学]