合并中重度肾损伤行冠状动脉旁路移植术患者的临床特征分析  

Coronary artery bypass grafting in patients with moderate to severe renal injury

作　　者：张航[1] 王梧圩 陈文[1] 秦卫[1] 项飞[1] 李良鹏[1] 虞敏[2] 陈鑫[1] ZHANG Hang;WANG Wu-wei;CHEN Wen;QIN Wei;XIANG Fei;LI Liang-peng;YU Min;CHEN Xin(Deparment of Thoracic and Cardiovuscular Surgery,Naujing Hospital Affiliated to Nanjing Medical University,Nanjing,first hospital,Nanjing Cardiovascular Hospital Nanjing 200006,China;Department of Cardiovscular Surger,Shanghai General Hospital Shanghai Jiao Tong University,School of Melidicine,Shanghai 200080,China)

机构地区：[1]南京医科大学附属南京医院(南京市第一医院)心胸血管外科,江苏省南京市210006 [2]上海交通大学附属第一人民医院心脏及大血管外科

出　　处：《中国心血管病研究》2020年第12期1093-1098,共6页Chinese Journal of Cardiovascular Research

基　　金：江苏省“科教强卫”专项基金:江苏省医学重点学科(实验室)(ZDXKA2016021)。

摘　　要：目的 分析在行体外循环冠状动脉旁路移植术(coronary artery bypass grafting,CABG)的患者中,术前合并中重度肾损伤者的临床特征及住院预后.方法 回顾性分析2013年1月至2018年12月在南京市第一医院单纯行CABG患者的病史资料,通过肾脏疾病饮食改良(modification of diet in renal disease,MDRD)简化公式计算肾小球滤过率(estimated glomerular filtration rate,eGFR),以60 ml·min-1·1.73m-2为界,将所有患者分为肾功能正常-轻度肾损伤组(eGFR≥60 ml·min-1·1.73m-2)和中-重度肾损伤组(eGFR<60 ml·min-1·1.73m-2),比较两组患者的入院基本资料、术前合并症、临床检查及化验和手术及住院预后情况,采用1:1倾向性评分分析(propensity score matching,PSM)平衡两组间基线资料的差异.结果 研究共纳入1466例患者,其中肾功能正常-轻度肾损伤组1333例,中-重度肾损伤组133例,9.1%的患者在术前合并中重度肾损伤.相比肾功能正常-轻度肾损伤组,中-重度肾损伤组患者年龄更大(62.8岁比69.0岁,P<0.001),心功能更差(纽约心功能Ⅲ~Ⅳ级55.1%比70.7%,P=0.001),所患糖尿病(32.1%比42.9%,P=0.012)、高血压(63.6%比79.7%,P<0.001)和周围血管疾病(0.2%比4.5%,P<0.001)的比例更多,左心室射血分数更低[62.0%(58.0%,65.0%)比62.0%(47.0%,65.0%),P=0.045],术中需IABP辅助比例(2.1%比5.3%,P=0.023)更多,两组患者的其他临床资料差异无统计学意义(P均>0.05).PSM对两组患者进行1:1匹配,匹配成功248例,每组各124例.在住院预后方面,中重度肾损伤组患者的重症监护室(ICU)监护时间(38.0 h比43.5 h,P=0.011)和住院时间(16.0 d比21.0 d,P<0.001)均更长,术后需要红细胞输注的比例(43.5%比58.9%,P=0.016)更多.散点图相关性分析提示,ICU监护时间和住院时间与患者术前eGFR水平呈线性负相关.两组病死率及其他并发症发生情况差异无统计学意义(P均>0.05).结论 中重度肾损伤并不增加CABG术后住院病死率,但是延长ICU监护和住�Objetive To analyze the climical feature and in hospial prognosis of ptients with moderate and severe real ijiny udergenc or-pump con artry bypass gratin(CABG).Methols The da of patiens who undewent on-pup CABG i Nanjing frst Hospia fom January 2013 to Deceber 2018 were clcte and analyzed.The estimated glomerular fltaton rat(eGFR)was calculated by simplified modification of diet in renal disease formula.All patients were divided ito two groups:normal renal function or mild reanal iniury grouop(eGFR>60 m·min^-1·1.73m)and modecet to severe renal injunry grouop(eGFR<60 m·min^-1.73m^-2).The basicec chracteristis,peoperative complicatins,clinica examination,sugical treatment and in-hospital prognosis of two groups were compared.The dfference of baseline data between the two groups were balanced by 1:1 propensity score analysis(PSM)and the shorterm prognosis was compared.Results A total of 1466 patients were included in this study,incluing 1333 patiets with normal renal function or mid renal injuy and 133 paicnts wih modert to severe renal injury There were 9.1%of the ptints had moderate to severe Trenal injury before in admssion.Compared with the normal renal function or mild renal injury group,the patients in the moderate to severe renal injury group were older(62.8 years old vs.69.0 years old,P<0.001),worse cardic function(New York Heart Asciaion Ⅲ-Ⅳ 55.1%vs.70.7%,P=0.001)and with more dabete(32.1%vs.4.9%,P=0.012),hyetensn(636.6% vs.79.7%,P<0.00)and perpherel vascular disease(0.2%vs.4.5%,P<0.001),lower left vnticular ection faction[62.0%6(58.0%,65.0%)vs.62.0%(47.0%,65.0%),P=0.045]and more IABP iplanatin(2.1%vs.5.3%,P=0.023)during the oprton.There was no sgnicnt difene in other cinical data betwen the two group(P>0.05).PSM matched the two groups of ptients 1:1 with the rate and 248 cases were matched sceefulll 124 cases in each group rspctielel In terms of in-hosptal prognosis,the IcU monitoring time(38.0 hours vs.43.5 hours,P<0.011)and length of stay(16.0 days vs.21.0 days,P<0.001)were longer in moderate to s

关 键 词：肾功能损伤 体外循环 冠状动脉旁路移植术 心脏外科手术 

分 类 号：R654.2[医药卫生—外科学]