术前收缩压对冠状动脉旁路移植术后急性肾损伤的影响  

Effect of preoperative systolic blood pressure on acute kidney injury after coronary artery bypass grafting

作　　者：郑辉[1] 樊国亮[2] 王正清[3] 刘志刚[3] 李雪粉[1] Zheng Hui;Fan Guoliang;Wang Zhengqing;Liu Zhigang;Li Xuefen(Department of Hypertension and Metabolism,TEDA International Cardiovascular Disease Hospital,Tianjin 300457,China;Department of Intensive Care Unit,TEDA International Cardiovascular Disease Hospital,Tianjin 300457,China;Department of Cardiovascular Surgery,TEDA International Cardiovascular Disease Hospital,Tianjin 300457,China)

机构地区：[1]泰达国际心血管病医院高血压代谢病科,天津300457 [2]泰达国际心血管病医院ICU,天津300457 [3]泰达国际心血管病医院心血管外科,天津300457

出　　处：《中华胸心血管外科杂志》2021年第5期297-302,共6页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：滨海新区卫计委一般支持项目(2014BWKY016)。

摘　　要：目的探讨冠状动脉旁路移植术(CABG)术后急性肾损伤(AKI)的危险因素,以及术前血压水平对AKI的影响。方法回顾性分析2016年1月至2017年12月期间980例在泰达国际心血管病医院心外科行CABG的患者资料,其中男706例,女274例,平均(61.9±8.0)岁。依据AKIN标准诊断AKI,根据是否发生AKI将患者分为急性肾损伤组(AKI组,86例)和无急性肾损伤组(non-AKI组,894例),比较两组间基线资料、围手术期相关资料。同时按照术前平均收缩压(SBP)水平分为低水平收缩压组(LSP组,374例,平均收缩压<120 mmHg,1 mmHg=0.133 kPa)、中水平收缩压组(MSP组,481例,平均收缩压120~140 mmHg)和高水平收缩压组(HSP组,125例,平均收缩压≥140 mmHg),作为分类协变量,应用二项logistic回归分析AKI的影响因素。结果全组患者AKI患病率8.7%(86/980)。与non-AKI组比较,AKI组术前SBP水平[(129.8±13.8)mmHg对(124.4±13.3)mmHg,P=0.000]、平均动脉压[(91.9±8.8)mmHg对(88.8±9.1)mmHg,P=0.004]和平均脉压差[(56.9±10.7)mmHg对(53.2±9.8)mmHg,P=0.001]显著升高,差异均有统计学意义。调整其他危险因素后,术前不同水平SBP(LSP、MSP和HSP)、高血压病史、体外循环、IABP的使用、二次开胸、术前应用利尿剂、术中输血和低肾小球滤过率是CABG术后AKI的独立危险因素。与LSP组相比,HSP组发生CABG术后AKI的相对危险度为2.743(95%CI:1.595~4.715)。有高血压病史的患者中,HSP组AKI患病率显著高于LSP组(18.4%对8.1%,P=0.001),否认高血压病史患者的术前血压水平对术后AKI发生无影响。结论术前SBP是CABG术后AKI的危险因素。高血压患者术前SBP控制在140 mmHg以下能显著减少CABG术后AKI的发生。Objective To observe the risk factors of acute renal injury(AKI)after coronary artery bypass grafting(CABG)and the influence of blood pressure on AKI.Methods 980 patients in CABG of Cardiology Department of TEDA International Cardiovascular Hospital were diagnosed with AKI according to the AKIN standard,with 706 males and 274 females,averaged(61.9±8.0)years old.Patients were divided into two groups according to whether AKI occurred:AKI group(86 cases)and non AKI group(894 cases).The baseline clinical data,operation related data were compared between the two groups.At the same time,according to the preoperative mean systolic blood pressure(SBP)level,LSP[mean systolic blood pressure<120 mmHg(1 mmHg=0.133 kPa),374 cases],MSP(mean systolic blood pressure 120-140 mmHg,481 cases)and HSP(mean systolic blood pressure≥140 mmHg,125 cases)were classified as covariates,and the influencing factors of dependent variable AKI were analyzed by multivariate logistic regression.Results The prevalence of AKI was 8.7%(86/980).Compared with non-AKI group,preoperative SBP[(129.8±13.8)mmHg vs.(124.4±13.3)mmHg,P=0.000],mean arterial pressure[(91.9±8.8)mmHg vs.(88.8±9.1)mmHg,P=0.004],and mean pulse pressure[(56.9±10.7)mmHg vs.(53.2±9.8)mmHg,P=0.001]were increased significantly.After adjusted for other risk factors,preoperative SBP elevation,hypertension history,cardiopulmonary bypass(CPB),use of intra-aortic-balloon-pump(IABP),secondary thoracotomy,preoperative diuresis,intraoperative blood transfusion and baseline low glomerular filtration rate(eGFR)were independent risk factors for AKI after CABG.Compared with LSP group,the relative risk of AKI after CABG in HSP group was 2.743(95%CI:1.595-4.715).In patients with hypertension history,AKI in HSP group was significantly higher than that in LSP group(18.4%vs.8.1%,P=0.001).However,the preoperative blood pressure level of patients who denied the history of hypertension had no effect on AKI.Conclusion Preoperative SBP is a risk factor for AKI after CABG.The incidence of AKI after CAB

关 键 词：冠状动脉旁路移植术 急性肾损伤 收缩压 高血压 

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