围术期血清胆红素水平对心脏体外循环术后急性肾损伤的影响  

Effect of perioperative serum bilirubin level on the incidence of acute kidney injury after cardiopulmonary bypass

作　　者：李磊 邓泓博 李召水 生伟 池一凡 牛兆倬 LI Lei;DENG Hongbo;LI Zhaoshu;SHENG Wei;CHI Yifan;NIU Zhaozhuo(Cardiovascular,Qingdao Municipal Hospital,Dalian Medical University,Dalian 266071,China)

机构地区：[1]大连医科大学附属青岛市市立医院心脏中心,266607

出　　处：《心肺血管病杂志》2020年第5期590-593,共4页Journal of Cardiovascular and Pulmonary Diseases

基　　金：青岛市卫计委课题(2018-WJZD009)。

摘　　要：目的:研究术后血清总胆红素水平(TBIL)与心脏体外循环术后急性肾损伤发生的关系,评估其对体外循环术后急性肾损伤发生的预测价值。方法:回顾性分析2018年1月至2019年8月,在我院行体外循环手术的230例患者临床资料,收集患者术后48 h TBIL水平,根据水平,将患者分为TBIL>34.2μmol/L和正常胆红素组。比较两组患者的年龄、性别、合并症、肝功能指标(GOT,GPT)、手术时间、术中输液量、血清肌酐水平、术后发生急性肾损伤情况及连续性肾脏替代治疗使用率等。结果:研究对象中共有68例患者(29.6%)纳入高胆红素组,其中30例患者(44.1%)发生急性肾损伤(OR=3.673,95%CI:1.984~6.230,P<0.001)。校正后行多因素Logistic回归分析显示,术后高胆红素血症、年龄、心功能分级、术前合并症(高血压、糖尿病)、BMI>30 kg/m^2、体外循环时间、术后低血压与急性肾损伤相关(P<0.05)。结论:高胆红素血症是心脏体外循环术后急性肾损伤发生的危险因素。Objective:To investigate the relationship between postoperative serum total bilirubin level(TBIL)and acute renal injury after cardiopulmonary bypass(CPB),and to evaluate its predictive value for acute renal injury(AKI).Methods:A retrospective analysis was made on 230 patients who underwent cardiopulmonary bypass in our hospital from January 2018 to August 2019.Patients were divided into high-bilirubin group(TBIL>34.2 μmol/L)and the normal bilirubin group,based on the serum bilirubin levels 48 hours after sur-gery.The age,sex,comorbidity,GOT,GPT,operative time,intraoperative infusion volume,serum creatinine level,postoperative acute kidney injury(AKI)and continuous renal replacement therapy were compared between the two groups.Results:A total of 68 patients(29.6%)were included in the high-bilirubin group,and 30 patients(44.1%)developed postoperative AKI(OR=3.673,95%CI:1.984-6.230,P<0.001).Multivariate Logistic regression analysis showed that age,diabetes,hypertension,preoperative hyperbilirubinemia,BMI>30 kg/m2,CPB time,postoperative hypotension were associated with postoperative AKI.Conclusions:Hyperbilirubinemia might be regarded as an independent risk factor of AKI following cardiac surgery.

关 键 词：体外循环 血清胆红素 急性肾损伤 

分 类 号：R54[医药卫生—心血管疾病]