不停跳冠状动脉旁路移植术后急性肾损伤的影响因素探讨及3年随访结果

发布时间：2019-04-21 11:23

【摘要】：目的:探讨急性肾损伤(acute kidney injury,AKI)在不停跳冠状动脉旁路移植(coronary artery bypass grafting,CABG)术后的发生率、相关危险因素以及比较AKI对围手术期并发症和术后3年的主要心脑血管不良事件(major adverse cardiovascular and cerebrovascular events,MACCE)的影响。方法:选择2010年1月至2012年3月连续行择期不停跳CABG的299例患者为研究对象,以是否发生AKI把患者分为AKI组和对照组,比较两组间围手术期临床资料的差异,使用Logistic后退法回归分析寻找AKI的危险因素;比较两组间术后并发症的差异,随访3年观察AKI对MACCE的影响。结果:术后37.1%(111/299)患者发生AKI,Logistic后退法多因素回归分析显示术前血肌酐升高(Wald=9.276,P=0.002,95%CI 1.006~1.028)、合并慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD,Wald=3.469,P=0.063,95%CI 0.950~7.630)、左心室射血分数(left ventricular ejection fraction,LVEF)降低(Wald=4.414,P=0.036,95%CI 0.965~0.999)、术前或术中植入主动脉内球囊反搏(intraaortic balloon pump,IABP,Wald=6.745,P=0.009,95%CI 1.336~7.925)是术后AKI的危险因素。AKI组患者术后并发症较多,如使用呼吸机时间、监护室停留时间、二次气管插管、肺部感染、脑卒中、消化道出血、术后住院时间、异体输血量(血浆和红细胞)和透析替代治疗均明显高于对照组(P0.05)。围术期两组间死亡率差异没有统计学意义,但是2例死亡患者均在AKI组。随访3年两组间MACCE差异没有统计学意义。结论:不停跳CABG术后AKI有较高的发生率(37.1%),术前血肌酐升高、合并COPD、LVEF降低、术前或术中植入IABP是术后AKI的独立的危险因素,AKI组围手术期并发症较多,随访3年两组间MACCE差异没有统计学意义。
[Abstract]:Objective: to investigate the incidence of acute renal injury (acute kidney injury,AKI) after beating coronary artery bypass grafting (coronary artery bypass grafting,CABG). The risk factors and the effects of AKI on perioperative complications and major cardiovascular and cerebrovascular adverse events (major adverse cardiovascular and cerebrovascular events,MACCE) in 3 years after operation were compared. Methods: from January 2010 to March 2012, 299 patients with continuous beating CABG were selected and divided into AKI group and control group according to the occurrence of AKI. The difference of clinical data between the two groups during perioperative period was compared. Logistic regression analysis was used to find the risk factors of AKI. The differences of postoperative complications between the two groups were compared, and the effect of AKI on MACCE was observed after 3 years of follow-up. Results: multivariate regression analysis showed that the preoperative serum creatinine level (Wald=9.276,P=0.002,95%CI 1.006, 1.028) and chronic obstructive pulmonary disease (chronic obstructive pulmonary disease,COPD,) were increased in 37.1% (111 / 299) patients with AKI,Logistic regression. Wald=3.469,P=0.063,95%CI 0.950? 7.630), left ventricular ejection fraction (left ventricular ejection fraction,LVEF) decreased (Wald=4.414,P=0.036,95%CI 0.965? 0.999), intraaortic balloon counterpulsation (intraaortic balloon pump,IABP,Wald=6.745,) implanted before or during operation? The patients in AKI group had more complications, such as ventilator time, stay time in custody unit, secondary tracheal intubation, pulmonary infection, stroke, gastrointestinal bleeding, and so on, the risk factors of postoperative AKI were 0.009, 95% CI 1.336x7.925 (P = 0.009, 95% CI 1.336x7.925). Postoperative hospital stay, allogeneic blood transfusion (plasma and red blood cells) and dialysis replacement therapy were significantly higher than those in the control group (P0.05). There was no significant difference in mortality between the two groups during perioperative period, but both patients died in AKI group. There was no significant difference in MACCE between the two groups after 3-year follow-up. Conclusion: the incidence of AKI after beating CABG is higher (37.1%). Preoperative serum creatinine is increased and COPD,LVEF is decreased. Preoperative or intraoperative implantation of IABP is an independent risk factor for postoperative AKI. There are many perioperative complications in AKI group. There was no significant difference in MACCE between the two groups after 3-year follow-up.
【作者单位】：北京大学第一医院心脏外科;
【分类号】：R654.2;R692

【参考文献】