不同程度慢性肾功能不全对冠心病患者非体外循环冠状动脉旁路移植术后早期疗效的影响对比  

Effects of different degrees of chronic renal insufficiency on early outcome of off-pump coronaryartery bypass grafting in postoperative patients with coronary heart disease:a comparative study

作　　者：徐殊 陶登顺 赵科研 王强 贺元辰 历志 王辉山 XU Shu;TAO Deng-shun;ZHAO Ke-yan;WANG Qiang;HE Yuan-chen;LI Zhi;WANG Hui-shan(Department of Cardiovascular Surgery,Chinese PLA Northern Theater Command General Hospital,Shenyang 110016,China)

机构地区：[1]中国人民解放军北部战区总医院心血管外科,辽宁省沈阳市110016

出　　处：《广西医学》2021年第1期7-10,共4页Guangxi Medical Journal

基　　金：辽宁省科学技术计划(20180550847)。

摘　　要：目的探讨术前不同程度慢性肾功能不全对冠心病患者心脏不停跳非体外循环冠状动脉旁路移植术(OPCABG)早期疗效的影响差异。方法回顾性分析接受单纯OPCABG手术的66例慢性肾功能不全患者的临床资料,并根据术前慢性肾功能不全程度分为轻度慢性肾功能不全组(A组)53例和重度慢性肾功能不全组(B组)13例。比较两组患者术前、术中及术后的临床资料。结果两组患者术中经皮主动脉内球囊反搏术(IABP)使用率、桥血管数及乳内动脉使用率、住院死亡率、二次开胸止血率、呼吸机使用时间、ICU停留时间、术后住院时间、总住院时间、累计引流量、是否输血及血浆使用量比较,差异均无统计学意义(均P>0.05),但B组住院费用、术后连续性肾脏替代治疗(CRRT)使用率及红细胞使用量均高于A组(均P<0.05)。两组患者均无术后脑血管并发症、围术期心肌梗死、术后IABP使用。两组患者的血肌酐水平均具有随时间延长而变化的趋势,其中A组各时点的血肌酐水平均低于B组(均P<0.05)。结论不同程度慢性肾功能不全的冠心病患者接受OPCABG手术治疗对短期疗效的影响差异较小,但重度慢性肾功能不全会明显增加患者的住院费用、术后CRRT使用率及红细胞使用量,且不同程度慢性肾功能不全的冠心病患者在OPCABG围术期不同的时间节点的血肌酐水平存在差异。Objective To investigate differences in the effects of different degrees of preoperative chronic renal insufficiency on the early outcome of beating-heart off-pump coronary artery bypass grafting(OPCABG)in patients with coronary heart disease.Methods The clinical data of 66 patients with chronic renal insufficiency who underwent simple OPCABG procedure were retrospectively analyzed.According to the degree of preoperative chronic renal insufficiency,the patients were divided into mild chronic renal insufficiency group(group A,53 cases)and severe chronic renal insufficiency group(group B,13 cases).The preoperative,intraoperative and postoperative clinical data of the two groups were compared.Results There was no statistically significant difference between the two groups in utilization rate of intra-aortic balloon pumping(IABP),number of bridging vessels,utilization rate of internal mammary artery during operation,mortality rate in hospitalization,hemostasis rate of second thoracotomy,duration of ventilator use,ICU stay,postoperative hospital stay,total hospitalization time,cumulative drainage volume,presence of blood transfusion,or plasma consumption(all P>0.05).However,the hospitalization expenses,utilization rate of postoperative continuous renal replacement therapy(CRRT),and erythrocyte consumption in group B were higher than those in group A(all P<0.05).There were no postoperative cerebrovascular complications,perioperative myocardial infarction or postoperative IABP use in the two groups.Serum creatinine level exhibited a tendency to change over time in the two groups,wherein serum creatinine level at each time point in group A was lower than that in group B(all P<0.05).Conclusion Minor differences are observed in the effects of OPCABG procedure on the short-term efficacy in coronary heart disease patients with different degrees of chronic renal insufficiency.However,patients with severe chronic renal insufficiency have significantly increased hospitalization expenses,elevated postoperative CRRT utilization r

关 键 词：慢性肾功能不全 非体外循环冠状动脉旁路移植术 心脏不停跳 肌酐 冠心病 疗效 

分 类 号：R692.5[医药卫生—泌尿科学]