冠状动脉旁路移植术后急性肾损伤影响因素及预后  

Risk factor and prognosis of acute kidney injury after coronary artery bypass grafting

作　　者：樊国亮 王正清[2] 唐渊[2] 李民 张宁[2] 刘志刚 FAN Guoliang;WANG Zhengqing;TANG Yuan;LI Min;ZHANG Ning;LIU Zhigang(Department of cardiac surgery Shanghai East Hospital Affiliated Tongji University,shanghai 200120,China;Department of cardiac surgery TEDA International Cardiovascular Hospital,Tianjin 300457,China)

机构地区：[1]同济大学附属上海市东方医院心脏外科,上海200120 [2]泰达国际心血管病医院心脏大血管外科

出　　处：《肾脏病与透析肾移植杂志》2020年第2期114-118,共5页Chinese Journal of Nephrology,Dialysis & Transplantation

基　　金：国家重点研发专项(2016YFC1302001)。

摘　　要：目的:分析冠状动脉旁路移植术(CABG)后急性肾损伤(AKI)发生的危险因素。方法:回顾性分析1449例择期行CABG患者的临床资料,分析发生AKI的可能相关危险因素。结果:1449例患者中,132例发生AKI(9.1%),AKI组术后30d死亡25例(18.9%),显著高于非AKI组的死亡率(0.2%)。Logistic回归分析显示:术后肺炎(OR=4.55795%CI 2.186~9.499)、呼吸机应用>36h(OR=3.95395%CI 2.316~6.748)、二次气管插管(OR=4.03895%CI 1.455~11.202)、切口感染(OR=5.60595%CI 2.354~13.345)、体外循环时间(CPB)>2h(OR=1.75495%CI 1.115~2.759)(P<0.05)是CABG术后AKI发生的独立危险因素。结论:CABG术后AKI显著增加术后30d死亡率,其独立危险因素包括CPB和呼吸机时间长、术后并发肺炎和切口感染等,临床上应积极采取针对措施以期改善预后。Objective:To analyze risk factor and prognosis of acute kidney injury(AKI)after coronary artery bypass grafting(CABG).Methodology:Clinical data of 1449 patients under went CABG were analyzed retrospectively.The risk factors of AKI were analyzed by logistic regression.Results:There were 132 cases(9.1%)met the criteria of AKI after CABG,25 cases(18.9%)of them died within 30 days after the operation,the mortality was significantly higher than those without AKI(0.2%).Logistic regression analysis showed that,postoperative pneumonia(OR=4.557,95%CI 2.186-9.499),ventilator application time>36 h(OR=3.953,95%CI 2.316-6.748),reintubation(OR=4.038,95%CI 1.455-11.202),incision infection(OR=5.605,95%CI 2.354-13.345),cardiopulmonary bypass time>2 h(OR=1.754,95%CI 1.115-2.759)(P<0.05)were independent risk factors for AKI after CABG.Conclusion:AKI after CABG significantly increase the mortality of patients,independent risk factor of AKI includes CPB and ventilator time,postoperative pneumonia and incision infection.

关 键 词：冠状动脉旁路移植术 急性肾损伤 死亡率 危险因素 

分 类 号：R654.2[医药卫生—外科学] R692.5[医药卫生—临床医学]