体外循环和非体外循环冠状动脉旁路移植术对肾功能不全患者肾脏功能的损伤比较  

Renal function impairment of on-pump versus off-pump coronary artery bypass grafting in patients with renal dysfunction

作　　者：何勇[1] 李中杰[1] 刘光强[1] 陈冲[1] 谢学弟 黄创业[1] HE Yong;LI Zhong-jie;LIU Guang-qiang;CHEN Chong;XIE Xue-di;HUANG Chuang-ye(Department of Cardiac Surgery, Gaozhou People’s Hospital, Maoming,Guangdong 525200,China)

机构地区：[1]广东高州市人民医院心外科

出　　处：《中国临床研究》2019年第9期1185-1188,共4页Chinese Journal of Clinical Research

基　　金：广东省医学科学技术研究基金(A2018475)~~

摘　　要：目的探讨比较体外循环和非体外循环冠状动脉旁路移植术对肾功能不全患者肾功能的影响。方法选取2015年12月至2018年10月接受冠状动脉旁路移植术的肾功能不全患者共120例,随机分为体外循环组和非体外循环组,每组60例。比较两组患者术后12 h、1 d、3 d、5 d的肾脏功能;比较患者术后恢复情况,包括术后插管时间、住ICU时间、输血量、总住院时间及术后并发症的发生率。结果两组患者术后12 h血肌酐水平差异无统计学意义(P>0.05),但术后1 d、 3 d和5 d,体外循环组患者血肌酐水平显著高于非体外循环组(P<0.05)。体外循环组患者术后有7例患者(11.67%)采用肾脏替代治疗,而非体外循环组中仅1例患者(1.67%)术后接受肾脏替代治疗,体外循环组患者的术后肾脏替代治疗发生率显著高于非体外循环组(P<0.05)。体外循环组患者术后气管插管时间、ICU住院时间、总住院时间均显著长于非体外循环组(P<0.05)。两组患者的术后输血量差异无统计学意义(P>0.05)。两组患者术后心房颤动和二次开胸比例差异均无统计学意义(P>0.05),但体外循环组的感染率显著高于非体外循环组(P<0.05)。无术后住院死亡病例。结论与体外循环手术相比,非体外循环冠状动脉旁路移植术在治疗冠状动脉心脏病合并慢性肾功能不全患者可降低患者术后接受肾脏替代治疗的风险,降低术后感染率,加快术后康复速度。Objective To investigate and compare the influences of on-pump and off-pump coronary artery bypass grafting(CABG) surgery on renal function in patients with coronary heart disease(CHD) complicated with renal dysfunction.Methods A total of 120 CHD patients with renal dysfunction undergoing CABG surgery were recruited in this study and were randomly divided into off-pump CABG group and on-pump CABG group(n=60,each).The renal functions were monitored and compared at 12 hours,1-,3-and 5-day after surgery.The post-operative situations,including intubation time,ICU hospital stay,blood transfusion volume,total hospitalization time and incidence of complications were compared between two groups.Results The serum creatinine(Cr) levels were similar at 12 hours after operation between two groups(P>0.05),but were significantly higher in on-pump group than those in off-pump group at 1-,3-and 5-day after operation(all P<0.05).The incidence of renal replacement therapy in on-pump group was significantly higher than that in off-pump group [7/60(11.67%) vs 1/60(1.67%),P<0.05)].The time of tracheal intubation,ICU stay and total hospitalization in on-pump group were significantly longer than those in off-pump group(all P<0.05).There were no significant differences in blood transfusion volume and the proportions of atrial fibrillation and secondary thoracotomy between two groups(P>0.05).The infection rate in on-pump group was significantly higher than that in off-pump group(P<0.05).None of the patients died in hospital after operation.Conclusion Compared to on-pump CABG,off-pump CABG could reduce the risk of post-operative renal replacement therapy and infection and promote postoperative recovery in CHD patients with renal dysfunction.

关 键 词：体外循环 冠状动脉旁路移植术 肾功能不全 冠状动脉心脏病 肌酐 肾脏替代治疗 住院时间 

分 类 号：R692.5[医药卫生—泌尿科学] R654.1[医药卫生—外科学]