左西孟旦对重症冠状动脉搭桥术后急性肾损伤的影响  

Effects of levosimendan on acute kidney injury in patients undergoing coronary artery bypass grafting

作　　者：裴锋博[1] 陈祖君[1] 吴慧[1] 龚黎[1] 刘红[1] 杜鹃[1] 姚垚[1] 张志鹏[1] 杨立猛[1] 郑哲[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,阜外医院SICU,心血管疾病国家重点实验室,北京100037

出　　处：《中国血液净化》2017年第11期725-727,745,共4页Chinese Journal of Blood Purification

摘　　要：目的研究左西孟旦对重症冠状动脉搭桥术后急性肾损伤的影响。方法前瞻性纳入2013年12月~2015年6月期间北京阜外医院成人外科恢复室收治的3支病变或合并左主干病变,行冠状动脉旁路移植(coronary artery bypass graft,CABG)手术治疗的冠状动脉粥样硬化性心脏病患者资料。随机分为左西孟旦组及对照组,2组按外科术后常规治疗,左西孟旦组在此基础上加用左西孟旦静脉泵入。结果共79例患者入选,其中左西孟旦组44例,对照组39例。术后2组患者肌酐水平均较术前增高,左西孟旦组患者肌酐从第3日起低于对照组[(102.0±14.7)μmol/L比(137.0±21.4)μmol/L],T值2.540,P=0.015。左西孟旦组术后共8例诊断为AKI(8/36),对照组共14例诊断为AKI(14/21),χ2=4.620,P值=0.032。出院时左西孟旦组患者肌酐水平小于对照组[(94.0±16.7)μmol/L比(119.0±17.6)μmol/L],t值2.540,P=0.017。多因素logistic回归示左西孟旦是术后AKI的保护性因素,OR值为0.680(0.420~0.870)。结论左西孟旦降低重症冠状动脉搭桥术后急性肾损伤的发生。Objective To investigate the effects of levosimendan on acute kidney injury （AKI） in patients undergoing coronary artery bypass grafting. Methods Critical patients undergoing coronary artery bypass grafting during Dec. 2013 to Jun 2015 treated in Fuwai Hospital were randomly divided into levosimendan treatment group and control group in this prospective study. Results A total of 79 patients were enrolled, 44 patients in levosimendan treatment group and 35 patients in control group. Plasma creatinine increased in both groups compared to the baseline value. Plasma creatinine was lower in levosimendan treatment group than in control group from Day 3 （102.0 ＆#177; 14.7 μmol/L vs. 137.0 ＆#177; 21.4 μmol/L; t=2.54, P=0.015）. The incidence of AKI was less in levosimendan treatment group than in control group （8/36 vs. 14/21;χ2=4.620, P=0.032）. Cre-atinine level was less in levosimendan treatment group than in control group at discharge （940.0 ＆#177; 16.7 vs. 119.0＆#177;17.6 μmol/L;t=2.54, P=0.017）. Multivariate logistic regression showed that levosimendan was the pro-tective factor for postoperative AKI, OR：0.680 （0.420~0.870）. Conclusion Levosimendan reduces the in-cidence of AKI in critical patients undergoing coronary artery bypass grafting.

关 键 词：冠状动脉搭桥 急性肾损伤 左西孟旦 

分 类 号：R692.5[医药卫生—泌尿科学]