CAJ | 학술논문

目的探讨冠状动脉旁路移植术后急性肾损伤(AKI)的危险因素;明确体外循环是否是冠状动脉旁路移植术后独立危险因素.方法根据AKI诊断标准:选择2010年9月-2013年11月在南京市第一医院行冠状动脉旁路移植术的患者209例,分为AKI组55例和非AKI组154例,通过单因素及多因素分析比较两组间可能的相关危险因素.结果单因素分析中,AKI组中的性别(女性)、年龄、体重指数、高血压、基础血肌酐水平、心脏射血分数、冠状动脉粥样硬化数目、体外循环、主动脉球囊反博的循环支持、术后的低心排血量、乳酸水平均比非AKI组高(P＜0.05).多因素分析中,AKI组与非AKI组相比,基础血肌酐水平、心脏射血分数、体外循环、术后的低心排血量差异具有统计学意义(P＜0.05).结论围术期的多种因素与冠状动脉旁路移植术后AKI的发生密切相关,基础血肌酐水平、心脏射血分数、体外循环、术后的低心排血量是冠状动脉旁路移植术后独立危险因素,采用非体外循环下行冠状动脉旁路移植术,有利于肾脏保护.
목적 탐토관상동맥방로이식술후급성신손상(AKI)적위험인소;명학체외순배시부시관상동맥방로이식술후독립위험인소.방법 근거AKI진단표준:선택2010년9월-2013년11월재남경시제일의원행관상동맥방로이식술적환자209례,분위AKI조55례화비AKI조154례,통과단인소급다인소분석비교량조간가능적상관위험인소.결과 단인소분석중,AKI조중적성별(녀성)、년령、체중지수、고혈압、기출혈기항수평、심장사혈분수、관상동맥죽양경화수목、체외순배、주동맥구낭반박적순배지지、술후적저심배혈량、유산수평균비비AKI조고(P＜0.05).다인소분석중,AKI조여비AKI조상비,기출혈기항수평、심장사혈분수、체외순배、술후적저심배혈량차이구유통계학의의(P＜0.05).결론 위술기적다충인소여관상동맥방로이식술후AKI적발생밀절상관,기출혈기항수평、심장사혈분수、체외순배、술후적저심배혈량시관상동맥방로이식술후독립위험인소,채용비체외순배하행관상동맥방로이식술,유리우신장보호.
Objective To investigate the correlation of possible risk factors with acute renal injury (AKI) after coronary artery bypass surgery (CABG) and explore if the incidence of AKI could be lower by off-pump CABG for kidney protection.Methods Two hundred and nine patients who underwent coronary artery bypass surgery in Nanjing First Hospital from September 2010 to November 2013 were recruited.The patients were divided into AKI group (fifty-five cases) and non-AKI group (one hundred and fifty-four cases) according to the AKI criteria and compared the possible risk factors between two the groups by univariate analysis and multivariate analysis.Results The index of female gender,body mass index,age,hypertension,basic serum creatinine,ejection fraction,the number of coronary atherosclerosis,cardiopulmonary bypass,IABP for circulatory support,postoperative low cardiac output,lactate in AKI group were higher than that in non-AKI group by univariate analysis (P ＜ 0.05).And basic serum creatinine,ejection fraction,cardiopulmonary bypass,postoperative low cardiac output showed a significantly statistical difference between two group by multivariate analysis.Conclusions Cardiopulmonary bypass,basic serum creatinine,ejection fraction,postoperative low cardiac output were independent risk factors.Off-pump CABG could benefit for kidney protection.