合并终末期肾病和慢性肾脏病的冠心病患者行冠状动脉旁路移植术的疗效分析  

Comparison of coronary artery bypass graft surgery in patients with end-stage renal disease and chronic kidney disease

作　　者：胡霄竹[1] 李雪梅[1] 屈丽楠 韩晴[1] 李扬[1] 董然[1] HU Xiaozhu;LI Xuemei;QU Linan;HAN Qing;LI Yang;DONG Ran(Department of Cardiac Surgery,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所心外科,100029

出　　处：《心肺血管病杂志》2024年第4期397-401,409,共6页Journal of Cardiovascular and Pulmonary Diseases

基　　金：北京市医管局培育计划(PX2023024)。

摘　　要：目的:对比分析冠心病合并终末期肾病(end-stage renal disease,ESRD)和慢性肾脏病(chronic renal disease,CKD)的患者行CABG术效果及预后。方法:采集自2017年1月至2023年6月,我院心外科收治的514例术前合并肾功能不全的冠心病患者临床资料,包括72例术前接受血液透析治疗的ESRD患者和442例合并CKD(e GFR≤60 m L·min^(-1)·1.73m^(-2)但尚未行透析治疗)的患者。术前基线资料包括基础病史、实验室检验及心脏相关检查,术中和术后资料包括手术情况、围术期并发症及院内死亡率。随访初级终点事件为全因死亡,次级终点事件包括主要心脑血管事件(major cardiovascular and cerebrovascular events,MACCE)、再发脑卒中、再发心绞痛、再发心肌梗死和再次住院。结果:ESRD组围术期死亡率(6.9%)高于CKD组(2.5%),但差异无统计学意义(P>0.05)。ESRD组术后二次开胸止血、围术期心肌梗死及术后心房颤动的发生率均高于CKD组(8.3%vs.2.9%,P=0.037,13.9%vs.6.3%,P=0.047,26.4%vs.15.4%,P=0.027)。ESRD组主动脉内球囊反搏的使用率高于CKD组(16.7%vs.8.4%,P=0.048),呼吸机辅助通气时间也长于后者[(56.3±23.0)vs.(38.5±16.1)h,P=0.007]。平均随访42(3,81)个月,ESRD组MACCE的发生率高于CKD组(30.6%vs.18.6%,P=0.041),再发心绞痛和再次脑卒中的发生率均高于后者(20.3%vs.10.1%,P=0.028;9.7%vs.3.5%,P=0.040),两组间远期生存率无统计学差异(82.3%vs.89.3%,P=0.133)。结论:合并ESRD和CKD的冠心病患者,行CABG术在院死亡率和长期生存率差异无统计学意义;ESRD患者围术期并发症的发生率及随访MACCE的发生率均高于CKD患者。Objective:To compare the clinical results and long-term prognosis of CABG in coronary heart disease(CAD)patients with end-stage renal disease(ESRD)and chronic kidney disease(CKD).Methods:The clinical data of 514 CAD patients combined with ESRD or CKD were collected from January 2017to June 2023,including 72 patients received dialysis treatment before operation and 442 patients with CKD(eGFR≤60 mL·min^(-1)·1.73m^(-2)).The perioperative and long-term follow-up results were completed.The primary end point is all-caused death,and the secondary end points include major cardiovascular and cerebrovascular events(MACCE),stroke,angina,myocardial infarction and recharge in-hospital.Results:The in-hospital mortality rates of the ESRD and CKD groups were 6.9%and 2.5%respectively,without statistically significant difference(P>0.05).The incidence of reoperation for bleeding and perioperative MI in ESRD patients was higher than those in CKD patients(8.3%vs.2.9%,P=0.037;13.9%vs.6.3%,P=0.047),and the incidence of new-onset atrial fibrillation was also higher in ESRD patients(26.4%vs.15.4%,P=0.027).The usage of intra-aortic balloon pump(IABP was higher in ESRD patients(16.7%vs.8.4%,P=0.048),and the support time of ventilator was also higher[(56.3±23.0)vs.(38.5±16.1)h,P=0.007]in the ESRD group.During the follow-up,the incidence of MACCE in the ESRD group was higher than that in the CKD group(30.6%vs.18.6%,P=0.041),and the rates of recurrence of angina and stroke were also higher than those in the CKD group(20.3%vs.10.1%,P=0.028;9.7%vs.3.5%,P=0.040).There was no statistical difference in the long-term survival rate between the two groups(82.3%vs.89.3%,P=0.133).Conclusions:For the CAD patients received dialysis or combined with chronic renal insufficiency,the in-hospital mortality and long-term survival rate were comparable in both groups.The incidence of perioperative complications and follow-up MACCEs in ESRD patients are higher than those in patients with CKD.

关 键 词：主冠状动脉旁路移植术 终末期肾病 慢性肾功能不全 冠心病 

分 类 号：R54[医药卫生—心血管疾病]