60岁及以上冠状动脉旁路移植术患者术后急性肾损伤相关因素探讨  

Risk factors of acute kidney injury in elderly patients undergoing coronary artery bypass grafting

作　　者：卢志贺[1] 刘华强[2] 李俊生[1] 庞广辉[3] 周忠启[4] 李峥嵘[1] Lu Zhihe;Liu Huaqiang;Li Junsheng;Pang Guanghui;Zhou Zhongqi;Li Zhengrong(Department of Pharmacy,Linyi People′s Hospital,Linyi 276003,China;Department of Pharmacy,Qingdao Municipal Hospital,Qingdao 266011,China;Department of Cardiovascular Surgery,Linyi People′s Hospital,Linyi 276003,China;Department of Nephrology,Linyi People′s Hospital,Linyi 276003,China)

机构地区：[1]临沂市人民医院药学部,276003 [2]青岛市市立医院药学部,266011 [3]临沂市人民医院心血管外科,276003 [4]临沂市人民医院肾内科,276003

出　　处：《中华全科医师杂志》2021年第4期475-481,共7页Chinese Journal of General Practitioners

基　　金：山东省自然科学基金(ZR2019MH126);临沂市2018年科技创新发展计划(201818008)。

摘　　要：目的了解≥60岁冠状动脉旁路移植术(CABG)患者术后急性肾损伤(AKI)的发生率及相关危险因素。方法对2014年5月至2020年5月临沂市人民医院收治并接受单纯CABG 术的≥60岁423例患者的临床资料进行回顾性分析,按照是否发生AKI分为AKI组(62例)和对照组(361例)。收集可能与AKI发生相关的临床资料作为变量,采用logistic回归法分析发生AKI的独立相关因素。结果 423例患者年龄60~85岁,其中男287例、女136例。CABG 术后AKI发生率为14.7%(62/423)。与对照组相比,AKI组高血压病[71.0%(44/62)比50.7%(183/361),χ^(2)=8.75,P<0.01]、NYHA心功能分级≥Ⅲ级[38.7%(24/62)比7.5%(27/361),χ^(2)=48.67,P<0.01]、心房颤动[16.1%(10/62)比4.4%(16/361),χ^(2)=12.55,P<0.01]、行体外循环的患者比例较高[51.6%(32/62)比21.3%(77/361),χ^(2) =25.37,P<0.01],而术前常规使用他汀类药物患者比例更低[ 59.7%(37/62)比85.6%(309/361),χ^(2) =23.87,P<0.01];血尿酸[353.8(275.5,462.5)比314.5(262.9,383.6)μmol/L,Z=2.75,P=0.01]、血尿素氮 [ 5.5(4.3, 8.2)比5.1(4.3, 6.4)mmol/L,Z=2.44,P=0.02]、血清肌酐水平[74.9(58.5, 92.7)比67.0(57.1, 76.3)μmol/L,Z=2.90,P=0.01]更高;手术时间更长[(4.0±0.9)比(3.7±0.8) h,t=2.83,P=0.01],术中失血量[(403.2±124.1)比(350.6±110.2) ml,t=3.41,P<0.01]、桥血管数量[(3.8±0.7)比(3.5±0.8)支,t =3.58,P<0.01]更多。logistic多因素回归分析结果显示,术前NYHA心功能≥Ⅲ级(OR=8.528,95%CI:3.734~19.477,P<0.01)、高血压病(OR=6.455,95%CI:2.605~15.997,P<0.01)、术中行体外循环(OR=3.046,95%CI:1.190~7.795,P=0.02)、患糖尿病(OR=2.294,95%CI:1.047~5.026,P=0.04)、术前尿酸水平升高(OR=1.004,95%CI:1.000~1.008,P=0.03)是≥60岁患者CABG术后发生AKI的独立相关因素,术前常规使用他汀类药物是CABG术后发生AKI的保护因素(OR=0.366,95%CI:0.154~0.873,P=0.02)。结论≥60岁CABG患者术后发生AKI常见,术前心功能≥Ⅲ级、高血压病、糖尿病、术中采用体外循环、术前尿酸水平升�Objective To analyze the risk factors of acute renal injury(AKI)after coronary artery bypass grafting(CABG)in the elderly patients.Methods A total of 423 patients aged over 60 years who underwent CABG in Linyi People′s Hospital from May 2014 to May 2010 were retrospectively analyzed.Patients were divided into AKI group and control group according to whether AKI occurred.The risk factors of AKI were analyzed by multivariate logistic regression.Results Among the 423 patients,62 cases(14.7%)developed postoperative acute kidney injury.Compared with the patients without AKI(n=361),the proportions of patients with hypertension,heart function(NYHA)≥Ⅲ,atrial fibrillation and cardiopulmonary bypass were higher in AKI group,the proportion of patients using statins before operation was lower[71.0%(44/62)vs.50.7%(183/361),χ^(2)=8.75,P<0.01;38.77%(24/62)vs.7.5%(27/361),χ^(2)=48.67,P<0.01;16.1%(10/62)vs.4.4%(16/361),χ^(2)=12.55,P<0.01;51.6%(32/62)vs.21.3%(77/361),χ^(2)=25.37,P<0.01;59.7%(37/62)vs.85.6%(309/361),χ^(2)=23.87,P<0.01].Patients in AKI group had higher level of blood uric acid,urea nitrogen and creatinine[353.8(275.5,462.5)μmol/L vs.314.5(262.9,383.6)μmol/L,Z=2.75,P=0.01;5.5(4.3,8.2)mmol/L vs.5.1(4.3,6.4)mmol/L,Z=2.44,P=0.02;74.9(58.5,92.7)μmol/L vs.67.0(57.1,76.3)μmol/L,Z=2.90,P=0.01];and longer operation time,more blood loss and blood vessel bridge than those in control group[(403.2±124.1)vs.(350.6±110.2),t=3.41,P<0.01;(4.0±0.9)vs.(3.7±0.8),t=2.83,P=0.01;(3.8±0.7)vs.(3.5±0.8),t=3.58,P<0.01].The multivariate logistic regression analysis showed that preoperative cardiac function(NYHA)≥Ⅲ(OR=8.528,95%CI:3.734-19.477,P<0.01),hypertension(OR=6.455,95%CI:2.605-15.997,P<0.01),extracorporeal circulation(OR=3.046,95%CI:1.190-7.795,P=0.02),diabetes mellitus(OR=2.294,95%CI:1.047-5.026,P=0.04),elevated serum uric acid level(OR=1.004,95%CI:1.000-1.008,P=0.03)were the independent risk factors for AKI.Statins is a protective factor for postoperative AKI(OR=0.366,95%CI:0.154-0.873,P=0.02).Conclusions AKI i

关 键 词：冠状动脉旁路移植术 非体外循环 肾功能不全 老年人 危险因素 

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