[1]席雷,王正清,刘志刚,等.体外循环对冠状动脉旁路移植术后患者早期急性肾损伤的影响[J].第三军医大学学报,2018,40(12):1142-1147.
 XI Lei,WANG Zhengqing,LIU Zhigang,et al.Impact of on-pump versus off-pump coronary artery bypass grafting on postoperative early acute kidney injury[J].J Third Mil Med Univ,2018,40(12):1142-1147.
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体外循环对冠状动脉旁路移植术后患者早期急性肾损伤的影响(/HTML )
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《第三军医大学学报》[ISSN:1000-5404/CN:51-1095/R]

卷:
40卷
期数:
2018年第12期
页码:
1142-1147
栏目:
临床医学
出版日期:
2018-06-30

文章信息/Info

Title:
Impact of on-pump versus off-pump coronary artery bypass grafting on postoperative early acute kidney injury
作者:
席雷王正清刘志刚梁少杰滕磊
中国医学科学院北京协和医学院泰达国际心血管病医院心脏外科
Author(s):
XI Lei WANG Zhengqing LIU Zhigang LIANG Shaojie TENG

LeiDepartment of Cardiovascular Surgery, Teda International Cardiovascular Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Tianjin, 300457, China

关键词:
冠状动脉旁路移植术体外循环急性肾损伤
Keywords:
acute kidney injury coronary artery bypass grafting extracorporeal circulation prognosis
分类号:
R654.1;R654.2;R692.06
文献标志码:
A
摘要:

目的比较体外循环和非体外循环下冠状动脉旁路移植术(coronary artery bypass grafting, CABG)后早期急性肾损伤的发生情况,并分析急性肾损伤(acute kidney injury,AKI)发生的危险因素。方法回顾性收集我科2013年1月至2016年12月间诊断为冠心病并实施冠状动脉旁路移植术的患者588例[男性425例,女性163例,体质量(72.57±11.85)kg,年龄(67.21±9.35)岁]。根据体外循环辅助与否分为192例非体外循环组和396例体外循环组。回顾围手术期数据,运用Logistic单因素和多因素回归模型筛选术后AKI的相关独立危险因素。结果CABG的患者中术后早期急性肾损伤的发生率为12.1%(71/588),非体外循环组AKI发生率为6.3%(12/192),显著低于体外循环的14.9%(59/396,P<0.05)。回归分析结果显示:体外循环应用(OR=0.481,95%CI 0.244~0.950,P=0.035),高血压史(OR=2.793,95%CI  1.402~5.565,P=0.003)、左房内径(OR=1.063,95%CI  1.004~1.126,P=0.036)、左颈总或颈内动脉狭窄(OR=2.139,95%CI 1.214~3.769,P=0.009)、静脉桥远端吻合口数(OR=1.681,95%CI 1.225~2.306,P=0.001)以及血液制品应用(OR=4.421,95%CI 1.839~10.625,P=0.001)是CABG术后患者发生急性肾损伤所的独立危险因素。结论非体外循环下冠状动脉旁路移植术术后早期肾功能损伤明显优于体外循环下冠状动脉旁路移植术,制定手术方案时应当综合考虑和评估术前患者基线和基础状态。

Abstract:

ObjectiveTo compare the postoperative renal outcomes after on-pump versus conventional offpump coronary artery bypass grafting (CABG) and analyze the risk factors of acute kidney injury (AKI) following CABG. MethodsThe clinical data were retrospectively reviewed for 588 patients [including 425 male and 163 female patients with a mean body mass of (72.57±11.85) kg and a mean age of (67.21±9.35) years] with coronary heart diseases undergoing CABG in our department between January, 2013 and December, 2016. The perioperative data of the patients receiving on-pump CABG and off-pump CABG were compared and the risk factors of postoperative AKI were identified using univariate analysis and logistic regression analysis. ResultsThe overall incidence of AKI after CABG was 12.1% (71/588) in these patients, and the incidence was significantly lower in the off-pump group than in the on-pump group [6.3%(12/192) vs 14.9%(59/396), P<0.05]. Univariate and multivariate regression analyses identified the application of extracorporeal circulation (OR=0.481, 95%CI: 0.244~0.950, P=0.035), a history of hypertension (OR=2.793, 95%CI: 1.402~5.565,  P=0.03), left atrial diameter (OR=1.063, 95%CI: 1.004~1.126, P=0.036), left carotid artery stenosis (OR=2.139, 95%CI: 1.214~3.769, P=0.00), distal venous bridge anastomotic number (OR=1.681, 95%CI: 1.225~2.306, P=0.001) and the use of blood products (OR=4.421, 95%CI: 1.839~10.625, P=0.001) as the independent risk factors for postoperative AKI. ConclusionOffpump beatingheart CABG achieves better shortterm renal outcomes than conventional on-pump CABG, and the preoperative baseline and general condition of the patients should be considered in the surgical planning.

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更新日期/Last Update: 2018-07-03