非体外循环冠状动脉旁路移植术后急性肾损伤的危险因素  

Risk factors for postoperative acute kidney injury in patients undergoing off-pump coronary artery bypass grafting

作　　者：贺源 徐红党 林洪启 黑飞龙[3] He Yuan;Xu Hongdang;Lin Hongqi;Hei Feilong(Department of Anesthesiology and Perioperative Medicine,Zhengzhou University People′s Hospital,Henan Provincial People′s Hospital,Zhengzhou 450003,China;Department of Anesthesiology,Heart Center of Henan Provincial People′s Hospital,Fuwai Central China Cardiovascular Hospital,Fuwai Central China Cardiovascular Hospital of Zhengzhou University,Zhengzhou 450003,China;Department of Extracorporeal Circulation,Fuwai Hospital,Chinese Academy of Medical Science and Peking Union Medical College,Beijing 100037,China)

机构地区：[1]郑州大学人民医院(河南省人民医院)麻醉与围术期医学科,450003 [2]阜外华中心血管病医院河南省人民医院心脏中心郑州大学阜外华中心血管病医院麻醉科,450003 [3]中国医学科学院北京协和医学院国家心血管病中心心血管疾病国家重点实验室阜外医院体外循环中心,100037

出　　处：《中华麻醉学杂志》2021年第9期1079-1082,共4页Chinese Journal of Anesthesiology

基　　金：河南省医学科技攻关计划省部共建项目(SB201901098);河南省医学科技攻关计划联合共建项目(LHGJ20200104)。

摘　　要：目的筛选非体外循环冠状动脉旁路移植术(OPCABG)后急性肾损伤(AKI)的危险因素。方法回顾性分析2018年1月1日至2020年12月31日河南省人民医院心脏中心1426例择期OPCABG患者病历资料,包括性别、年龄、BMI、糖尿病病史、高血压病史、高血脂病史、COPD病史、脑血管疾病史、心肌梗死病史、NYHA心功能分级、Killip分级;术前最近1次的经胸超声左室射血分数、糖化血红蛋白、葡萄糖、血清肌酐测量值;手术持续时间、术中红细胞输注、晶体液、胶体液、自体血、失血量、尿量等液体出入量;术中低血压、围术期血糖最大差值(MGD)、术后48 h和7 d内血清肌酐浓度。依据KDIGO标准定义术后AKI,以患者术后是否发生AKI分为2组:AKI组和非AKI组。采用logistic回归分析筛选OPCABG后AKI的危险因素。结果最终纳入分析1203例,OPCABG后AKI发生率为28.1%。logistic回归分析结果显示,BMI、高血压病史、围术期血糖MGD是OPCABG后AKI的危险因素(P<0.05)。结论BMI、高血压病史、围术期血糖MGD是OPCABG后AKI的危险因素。Objective To identify the risk factors for postoperative acute kidney injury(AKI)in patients undergoing off-pump coronary artery bypass grafting(OPCABG).Methods The medical records of patients who underwent elective OPCABG from January 1,2018 to December 31,2020 from the Heart Center of Henan Provincial People′s Hospital,were retrospectively collected.The patient′s gender,age,body mass index,history of diabetes,history of hypertension,history of hyperlipidemia,history of chronic obstructive pulmonary disease,history of cerebrovascular disease,history of myocardial infarction,New York Heart Association classification of cardiac function,Killip classification,values of last left ventricular ejection fraction measured by transthoracic echocardiography before operation,glycosylated hemoglobin,glucose and serum creatinine,duration of operation,intraoperative fluid intake and output such as red blood cell infusion,crystal fluid,colloid fluid,autologous blood,blood loss and urine volume,intraoperative hypotension,perioperative maximal blood glucose difference(MGD)and serum creatinine concentrations within 48 h and 7 days were recorded.Postoperative AKI was defined according to the Kidney Disease Improving Global Outcomes criteria and the patients were divided into AKI group and non-AKI group according to whether AKI occurred after surgery.Logistic regression analysis was used to identify the risk factors for AKI after OPCABG.Results A total of 1203 patients were included in this study,and the incidence of AKI after OPCABG was 28.1%.Logistic regression analysis showed that body mass index,history of hypertension and perioperative MGD were risk factors for AKI after OPCABG(P<0.05).Conclusion Body mass index,history of hypertension and perioperative MGD are risk factors for AKI after OPCABG.

关 键 词：冠状动脉旁路移植术 非体外循环 急性肾损伤 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]