心脏外科手术术前冠状动脉造影与术后急性肾损伤相关性的单中心回顾性研究  

Correlation between preoperative coronary angiography and postoperative acute kidney injury in cardiac surgery:A retrospective study in a single center

作　　者：赵长缨 闫炀[1] 师桃[1] 李勇新[1] 李静[1] 刘雯雁[2] 刘淼淼[1] 郑幸龙[1] ZHAO Changying;YAN Yang;SHI Tao;LI Yongxin;LI Jing;LIU Wenyan;LIU Miaomiao;ZHENG Xinglong(Department of Cardiovascular Surgery,The First Affiliated Hospital of Xi’an Jiaotong University,Xi’an,710061,P.R.China;Department of Blood Purification,The First Affiliated Hospital of Xi’an Jiaotong University,Xi’an,710061,P.R.China)

机构地区：[1]西安交通大学第一附属医院心血管外科,西安710061 [2]西安交通大学第一附属医院血液净化科,西安710061

出　　处：《中国胸心血管外科临床杂志》2024年第12期1820-1825,共6页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：陕西省重点研发计划(2023-YBSF-482,2023-YBSF-242);西安交通大学第一附属医院临床研究项目(XJTU1AF2021CRF-028)。

摘　　要：目的探究心脏外科手术术前行冠状动脉造影与术后急性肾损伤(acute renal injury,AKI)的关系。方法回顾性分析西安交通大学第一附属医院2015年1月—2019年4月心脏手术术前30 d内接受冠状动脉造影患者的临床资料。采用单因素、多因素logistic回归分析探索术前冠状动脉造影和心脏手术间隔时间与术后AKI的关系。结果纳入1112例患者,其中男700例、女412例,中位年龄61(55,66)岁。术后AKI发生率为40.8%(454/1112),其中AKI 2~3期占比11.9%。多因素分析结果显示,患者年龄[OR=1.049,95%CI(1.022,1.077),P<0.001]、体重指数[OR=1.065,95%CI(1.010,1.123),P=0.020]和术前冠状动脉造影与心脏手术间隔时间<24 h[OR=1.625,95%CI(1.116,2.364),P=0.011]是术后AKI的独立危险因素。术前24 h内接受冠状动脉造影的患者其术后AKI的发生率较≥24 h者升高10.6%(P=0.004)。接受瓣膜手术联合或不联合冠状动脉旁路移植术的患者发生AKI的风险均高于单纯行冠状动脉旁路移植术的患者。发生AKI患者术后住院时间较未发生AKI患者延长2 d;在心脏手术前24 h内行冠状动脉造影并不延长住ICU时间或术后住院时间,也不会增加术后肾功能衰竭或死亡的风险。结论心脏手术前24 h内进行冠状动脉造影会增加术后发生AKI的风险。Objective To explore the relationship between preoperative coronary angiography and postoperative acute kidney injury(AKI)in cardiac surgery.Methods The clinical data of patients who underwent coronary angiography within 30 days before cardiac surgery in the First Affiliated Hospital of Xi’an Jiaotong University from January 2015 to April 2019 were retrospectively analyzed.Univariate analysis and multivariate logistic regression analyses were used to explore the relationship between the interval from preoperative coronary angiography to cardiac surgery and postoperative AKI.Results Finally 1112 patients were collected,including 700 males and 412 females,with a median age of 61(55,66)years.The incidence of postoperative AKI was 40.8%(454/1112),of which grade 2-3 AKI accounted for 11.9%.Multivariate analysis showed that age(OR=1.049,95%CI 1.022-1.077,P<0.001),body mass index(OR=1.065,95%CI 1.010-1.123,P=0.020)and time interval between preoperative coronary angiography and cardiac surgery within 24 hours(OR=1.625,95%CI 1.116-2.364,P=0.011)were independent predictors of postoperative AKI.Patients who underwent coronary angiography within 24 hours before surgery had a 10.6%higher incidence of postoperative AKI compared to those who underwent angiography≥24 hours before surgery(P=0.004).Patients who underwent valve surgery with or without coronary artery bypass grafting(CABG)had a higher risk of AKI than those who only underwent CABG.The in-hospital stay of patients who developed AKI was 2 days longer than those without AKI.However,undergoing coronary angiography within 24 hours before cardiac surgery did not prolong the length of ICU stay or hospital stay,nor did it increase the risk of death or renal failure after the operation.Conclusion Undergoing coronary angiography within 24 hours before cardiac surgery increases the risk of postoperative AKI.

关 键 词：急性肾损伤 冠状动脉造影 心脏手术 危险因素 

分 类 号：R654.2[医药卫生—外科学]