体外循环及非体外循环对冠状动脉移植术后急性肾损伤的影响

发布时间：2018-05-15 01:29

本文选题：心肺转流术 + 冠状动脉旁路移植术　；参考：《南京医科大学学报(自然科学版)》2017年06期

【摘要】：目的:应用倾向性评分匹配方法探讨体外循环及非体外循环两种冠状动脉旁路移植术式对术后急性肾损伤(acute kidney injury,AKI)的影响。方法:收集2008年1月—2012年12月在南京医科大学附属南京医院心脏外科进行体外循环下及非体外循环下行冠状动脉旁路移植术患者资料,应用倾向性评分匹配方法分析两组患者术后AKI的发生率及其影响因素。采用多因素Logistic回归分析影响术后AKI发生的危险因素。结果:共有770例冠状动脉旁路移植术患者符合纳入标准,根据手术方式分为体外循环组568例,非体外循环组202例。在倾向性评分匹配之前,体外循环组与非体外循环组各变量间(如射血分数、机械通气时间)差异均存在统计学意义。通过使用倾向性评分匹配方法,202例体外循环组和202例非体外循环组配对成功,体外循环组和非体外循环组各变量差异无统计学意义。倾向性评分匹配后的队列分析显示,体外循环组发生AKI 72例(占35.64%),非体外循环组发生AKI 46例(占22.77%),两组差异有统计学意义(χ~2=8.092,P=0.004);非体外循环组住院时间较体外循环组短,差异有统计学意义(χ~2=2.757,P0.05);体外循环和非体外循环组病死率差异无统计学意义(χ~2=0,P=1.000);两组患者肾脏替代的发生率差异无统计学意义。结论:非体外循环手术方式可降低术后AKI的发生率。
[Abstract]:Objective: to investigate the effects of coronary artery bypass grafting (CABG) and off-pump coronary artery bypass grafting (CABG) on acute kidney injury-AKI in patients with acute renal injury. Methods: from January 2008 to December 2012, coronary artery bypass grafting (CABG) was performed under cardiopulmonary bypass (CPB) and off-pump in the Department of Cardiac surgery, Nanjing Hospital affiliated to Nanjing Medical University. The incidence and influencing factors of postoperative AKI in two groups were analyzed by using tendency score matching method. Multivariate Logistic regression analysis was used to analyze the risk factors of postoperative AKI. Results: a total of 770 patients with coronary artery bypass grafting met the inclusion criteria. According to the operation mode, 568 patients were divided into cardiopulmonary bypass group and non-cardiopulmonary bypass group 202 patients. There were significant differences between the variables of CPB group and off-pump group (such as ejection fraction, mechanical ventilation time) before the matching of tendency score. The tendency score matching method was used to match 202 cases of cardiopulmonary bypass group and 202 cases of non-cardiopulmonary bypass group. There was no significant difference between cardiopulmonary bypass group and non-cardiopulmonary bypass group. Cohort analysis after matching tendency score showed that 72 cases (35.64%) of AKI occurred in cardiopulmonary bypass group and 46 cases (22.77%) occurred AKI in non-cardiopulmonary bypass group. The difference between the two groups was statistically significant (蠂 ~ (2) 8.092% P ~ (0.004), the hospitalization time of non-cardiopulmonary bypass group was shorter than that of cardiopulmonary bypass group. The difference was statistically significant (蠂 ~ 2 / 757 / P 0.05), while there was no significant difference in mortality between cardiopulmonary bypass and non-cardiopulmonary bypass (蠂 ~ (2 / 2) and no significant difference in the incidence of renal replacement between the two groups (蠂 ~ (2 / 2) and non-cardiopulmonary bypass (P ~ (0.05). Conclusion: off-pump operation can reduce the incidence of postoperative AKI.
【作者单位】：南京医科大学附属南京医院肾内科;
【基金】：国家自然科学基金(81370797) 江苏省临床医学科技专项(BL2014015)
【分类号】：R654.2;R692.5

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