分析体外循环不停跳冠脉搭桥术后急性肾损伤的危险因素及风险评估

发布时间：2018-04-09 05:09

  本文选题：体外循环　切入点：冠状动脉搭桥　出处：《首都医科大学》2017年硕士论文

【摘要】：目的分析体外循环不停跳冠脉搭桥术后急性肾损伤的危险因素及风险评估。方法对2015年1月1日至2016年12月31日期间,于北京安贞医院心脏外科收治的90例不稳定性心绞痛的患者,接受体外循环辅助下心脏不停跳冠状动脉旁路移植手术的病人进行回顾性研究。排除标准:(1)年龄18周岁;(2)术前已行肾脏替代治疗;(3)病案数据缺失;(4)患者术中死亡。根据全球急性肾损伤临床转归协作机构(Kidney Disease:Improving Global Outcomes,KDIGO)提出的急性肾损伤(acute kidney injury,AKI)诊断标准,全部患者被分为AKI组(n=29)与非AKI组(n=61)两组进行资料分析。将患者于我院住院期间所采集的临床数据录入数据库,运用T检验,U检验,χ2检验,Logistic回归分析等确定术后AKI的独立危险因素。根据相关危险因素指标优势比(odds ratio,OR)值构建风险预测评估系统,并验证拟合度。结果术后发生AKI患者29例(29/90,32.2%),单因素组间分析年龄,高血压病史,射血分数,估测肾小球滤过率水平,术中低血压时间60min,体外循环运转时间120min,桥血管数量,出血量,术后低血压时间60min,机械辅助呼吸时间40h,应用IABP辅助是此类手术发生术后AKI的危险因素。Logistic回归分析术前左心室射血分数EF(%)、术中CPB时间120min、术中低血压时间60min是术后发生AKI的独立危险因素。将变量分组后再行logistic多因素回归分析,得到评分系统如下:年龄≥65岁2分;EF45%为3分、45%≤EF50%为2分、50%≤EF55%为1分;体外循环时间120min为2分;低血压时间60min为1分;机械辅助呼吸40h为3分;IABP辅助为1分;估测肾小球滤过率100 mL/min/1.73m2以下每下降20增加1分。评分总计15分。结论左心室射血分数低下、体外循环时间120min、术中低血压时间60min是体外循环辅助不停跳冠脉搭桥术后急性肾损伤的独立危险因素。通过分析我们得到了针对体外循环辅助下不停跳冠脉搭桥术后发生AKI的总分15分的评分系统,超过7分提示术后并发AKI风险较高,具有一定判别能力,但需更大样本量的矫正。
[Abstract]:Objective to analyze the risk factors and risk assessment of acute renal injury after beating coronary artery bypass grafting under cardiopulmonary bypass (CPB).Methods from January 1, 2015 to December 31, 2016, 90 patients with unstable angina pectoris were treated in cardiac surgery, Anzhen Hospital, Beijing.A retrospective study was conducted in patients undergoing cardiopulmonary bypass (CPB)-assisted coronary artery bypass grafting (CABG).Exclusion criteria: 1) 18 years old / 2) preoperative renal replacement therapy / 3) absence of medical record data / 4) Intraoperative death.According to the diagnostic criteria proposed by Kidney Disease:Improving Global Outcomers KDIGO, all the patients were divided into two groups: AKI group (n = 29) and non-#en4# group (n = 61).The clinical data collected in our hospital were entered into the database, and the independent risk factors of postoperative AKI were determined by T test U test, 蠂 2 test and Logistic regression analysis.The risk prediction and evaluation system was constructed according to the odds odds odds ratio of the relative risk factors, and the fitting degree was verified.Results 29 cases of AKI occurred after operation. Age, history of hypertension, ejection fraction, glomerular filtration rate, hypotension time, cardiopulmonary bypass (CPB) time, graft blood vessel count and bleeding volume were analyzed in 29 patients with AKI.Postoperative hypotension time was 60 min, mechanically assisted respiration time was 40 h. IABP was used as a risk factor for postoperative AKI. Logistic regression analysis showed that left ventricular ejection fraction (LVEF) was used before operation, CPB time was 120 min and intraoperative hypotension time (60min) was postoperative.Independent risk factors for AKI.The logistic multivariate regression analysis was performed after the variables were grouped, and the scoring system was obtained as follows: age 鈮，

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