冠状动脉旁路移植术前E/e′及术后CVP与术后急性肾损伤的相关性  

Correlation between preoperative E/e′, postoperative CVP and postoperative AKI after coronary artery bypass grafting

作　　者：史坚 张静波[1] 骆静武 傅群峰[2] 高丛 王保申[1] SHI Jian;ZHANG Jingbo;LUO Jingwu;FU Qunfeng;GAO Cong;WANG Baoshen(Department of Cardiovascular Surgery,The First Central Hospital in Baoding,Baoding,Hebei,071000,China;Department of Ultrasonography,The First Central Hospital in Baoding;Department of Thoracic Surgery,The First Central Hospital in Baoding)

机构地区：[1]保定市第一中心医院心脏血管外科,河北保定071000 [2]保定市第一中心医院超声科 [3]保定市第一中心医院胸外科

出　　处：《临床心血管病杂志》2021年第11期1056-1061,共6页Journal of Clinical Cardiology

基　　金：保定市科技计划项目(No:1941ZF034)。

摘　　要：目的:探讨不停跳冠状动脉旁路移植术(off-pump coronary artery bypass grafting, OPCABG)术后急性肾损伤(acute kidney injury, AKI)的影响因素。方法:回顾性收集2015年1月—2021年5月共232例于心胸血管外科行OPCABG患者,排除肥厚性心肌病1例,既往存在肾功能衰竭行腹膜透析或血液透析患者2例,超声心动图所存留图像不能测量68例,最终本研究纳入161例患者。根据入院心脏超声中舒张早期二尖瓣血流峰值速度(E)与舒张早期二尖瓣瓣环峰值速度(e′)之比(E/e′)比值患者分为两组,E/e′≤15及E/e′>15组,分析数据后,行Logistic回归分析独立危险因素。结果:E/e′>15组患者较E/e′≤15组患者左室射血分数(LVEF)显著下降,术后中心静脉压(CVP)显著升高,术后人脑利钠肽(BNP)及高敏肌钙蛋白(Hs-TnI)显著升高,术后血肌酐(Cr)及术后尿素氮(BUN)显著升高。E/e′>15组患者AKI及低心排综合征的发生率较E/e′≤15组患者明显升高,同时ICU停留时间显著延长。E/e′>15组患者术后AKI的发生率明显升高。二元Logistic回归分析中,E/e′[OR=1.210,95%CI1.002~1.460,P=0.048]、CVP(OR=1.296,95%CI1.002~1.676,P=0.048)及术后BNP(OR=1.011,95%CI1.004~1.018,P=0.002)是OPCABG后AKI发生的独立危险因素。结论:在OPCABG后患者,术前E/e′及术后早期CVP水平可早期识别AKI的发生,为AKI的早期治疗提供有效依据。Objective: To observe the risk factors in acute kidney injury(AKI) after off-pump coronary artery bypass grafting(OPCABG). Methods: This was a retrospective, single-center observational study. From January 2015 to May 2021, a total of 161 patients underwent OPCABG were included. According to the ratio of early diastolic flow velocity(E) to early diastolic annular velocity(e′)(E/e′), the patients were divided into two groups: E/e′≤ 15 and E/e′>15 group. Results: The left ventricular ejection fraction(LVEF) of patients with E/e′>15 group was significantly lower, the central venous pressure(CVP) was significantly higher, the B-type natriuretic peptide(BNP) and high-sensitivity troponin I(HS TnI) were significantly higher than those of patients with E/e′≤15 group. Moreover, the serum creatinine(Cr) was significantly lower and blood urea nitrogen(BUN) significantly higher in E/e′>15 group. The incidence of AKI and low cardiac output syndrome in E/e′>15 group was significantly higher, and the ICU stay time was significantly longer than those in E/e′≤ 15 group. The incidence of AKI in patients in E/e′>15 group was significantly increased after OPCABG. In order to eliminate the confounding factors, the variables with statistical differences between AKI and non AKI patients were included in the binary logistic regression equation to evaluate their impact on the occurrence of AKI. E/e′(OR=1.210, 95%CI1.002-1.460, P=0.048), CVP(OR=1.296, 95%CI1.002-1.676, P=0.048) and postoperative BNP(OR=1.011, 95%CI1.004-1.018, P=0.002) were independent risk factors for AKI after OPCABG. Conclusion: Preoperative E/e′and early postoperative CVP levels can early identify the occurrence of AKI and provide effective basis for early treatment of AKI in patients after OPCABG.

关 键 词：急性肾损伤 不停跳冠状动脉旁路移植术 左室充盈压 中心静脉压 超声心动图 

分 类 号：R541.4[医药卫生—心血管疾病]