冠状动脉旁路移植术后急性肾损伤的发生情况与危险因素分析

杨立猛; 施野; 张志鹏; 邹亮; 陈伊; 杜娟

doi:10.3969/j.issn.1671-4091.2019.11.002

中国血液净化 >

2019 , Vol. 18 >Issue 11: 738 - 741

DOI: https://doi.org/10.3969/j.issn.1671-4091.2019.11.002

临床研究

冠状动脉旁路移植术后急性肾损伤的发生情况与危险因素分析

杨立猛 ,
施野 ,
张志鹏 ,
邹亮 ,
陈伊 ,
杜娟

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1. 中国医学科学院北京协和医学院国家心血管病中心阜外医院心血管疾病国家重点实验室

收稿日期: 2019-06-04

修回日期: 2019-07-26

网络出版日期: 2019-10-28

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Incidence and risk factors of acute renal injury after coronary artery bypass grafting

YANG Li-Meng ,
SHI Ye ,
ZHANG Zhi-Peng ,
ZOU Liang ,
CHEN Yi ,
DU Juan

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1State Key Laboratory of Cardiovascular Disease; Fuwai Hospital; National Center for Cardiovascular Diseases; Chinese Academy of Medical Sciences; Peking Union Medical College, Beijing 100037, China

Received date: 2019-06-04

Revised date: 2019-07-26

Online published: 2019-10-28

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摘要

【摘要】目的明确冠状动脉旁路移植手术(coronary artery bypass surgery,CABG)患者术后急性肾损伤发生情况及危险因素。方法回顾性收集阜外心血管病医院2011 年9 月～2013 年11 月间接受单纯CABG 的1615 例患者的临床资料。应用KDIGO(kidney disease improving global outcomes)诊断标准评估患者术后7 天发生肾损伤情况。应用Logistic 二元回归分析方法，最终明确CABG 患者术后急性肾损伤的发生情况及危险因素。结果研究最终收集1574 例患者完整临床资料，患者平均年龄为(60.3±8.4)岁，女性占20.5%，CABG 患者术后总的急性肾损伤发生率为70.2%。其中891 例(56.6%)患者符合急性肾损伤1 级标准，182 例(11.6%)患者符合急性肾损伤2 级标准，32 例(2.0%)患者符合急性肾损伤3 级标准。Logistic 回归分析显示:年龄(OR=1.04,95%CI:1.02～1.05, P＜0.001)、体外循环技术的应用(OR=1.53, 95% CI:1.23～1.92, P＜0.001)及术前左心室射血分数小于50%(OR=1.46, 95% CI: 1.01～2.09, P=0.042)是CABG 患者术后急性肾损伤的独立危险因素。冠状动脉旁路移植术患者术前最后一次肌酐水平(OR= 0.98, 95% CI: 0.97～0.99, P＜0.001)越低将更容易达到KDIGO 急性肾损伤的诊断标准。结论CABG 术患者术后急性肾损伤的发生率较高，需引起临床医师关注。年龄、应用体外循环、术前左心室射血分数小于50%是CABG 术后发生急性肾损伤的独立危险因素。术前肌酐水平较低患者更容易达到KDIGO急性肾损伤的诊断标准。

关键词： 冠状动脉分流术; 急性肾损伤; 危险因素

本文引用格式

杨立猛 , 施野 , 张志鹏 , 邹亮 , 陈伊 , 杜娟 . 冠状动脉旁路移植术后急性肾损伤的发生情况与危险因素分析[J]. 中国血液净化, 2019 , 18(11) : 738 -741 . DOI: 10.3969/j.issn.1671-4091.2019.11.002

Abstract

【Abstract】Objective To investigate the prevalence and risk factors of acute kidney injury (AKI) in patients after coronary artery bypass surgery (CABG). Methods In the period from September 2011 to November 2013, a total of 1,615 consecutive patients undergoing isolated CABG in Fuwai Hospital were enrolled in this retrospective study. Kidney Disease Improving Global Outcomes (KDIGO) diagnostic criteria were used to evaluate the kidney injury 7 days after surgery. Logistic regression model was used to analyze the potential risk factors for AKI. Results A total of 1,574 patients with complete clinical data were finally enrolled in this

study. The mean age of the patients was 60.3±8.4 years and 20.5% were females. Of the studied patients, 70.2% met the criteria for AKI, including 891 (56.6%) with AKI Ⅰ, 182 (11.6%) with AKI Ⅱ and 32 (2.0%) with AKI Ⅲ. Logistic regression analysis showed that age (OR=1.04, 95% CI 1.02～1.05, P＜0.001), cardiopulmonary bypass (OR=1.53, 95% CI 1.23～1.92, P＜0.001) and preoperative left ventricular ejection fraction (LVEF) <50% (OR=1.46, 95% CI 1.01～2.09, P=0.042) were the independent risk factors for postoperative AKI in CABG patients. In addition, CABG patients will be more likely to meet the AKI diagnostic criteria by KDIGO when their blood creatinine levels of the last preoperative measurements were lower (OR=0.98, 95%, CI 0.97～0.99, P＜0.001). Conclusion The higher incidence of postoperative AKI in CABG patients should be concerned by clinicians. Age, application of extracorporeal circulation and preoperative LVEF <50% are the independent risk factors for postoperative AKI in CABG patients. Patients with lower creatinine levels before bypass surgery were more likely to meet the AKI diagnostic criteria by KDIGO.

Key words： Coronary artery bypass; Acute kidney injury; Risk factor

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