冠脉搭桥术后肾功能损害的预测

The forecast of renal function injury after coronary artery bypass grafting

目的:探讨冠脉搭桥手术后肾功能损害的风险因素。方法:对1990年1月至2006年8月间849例单纯行冠状动脉搭桥手术的病例进行回顾性分析。采用Logistic回归模型分析急性肾损害的风险因素。血清肌酐(Scr)130～199μmol/L(1.47～2.25mg/dL)或肌酐清除率(Ccr)30～60ml/min作为急性肾损害的诊断标准。所有统计学分析均采用SPSS11.5软件。结果:Logistic回归模型分析急性肾损害的风险因素包括:射血分数≥50,射血分数≤30,脉压差≥60mmHg,外周血管硬化,糖尿病,急诊手术,三支病变,体重指数,术中及术后主动脉球囊反搏,心功能分级,体外循环。但是,EF≥50,术中及术后主动脉球囊反搏可能是保护因素(OR<1)。结论:急性肾损害是病情发展的重要阶段,阳性检测结果提示可能有肾损害的存在,应采取有效的措施及治疗方法,阻止肾功能的进一步恶化。

Objective：To investigate the risk factors for the development of renal function injury after coronary artery bypass surgery（CABG）.Methods：849 patients undergoing isolated CABG between January 1990 and August 2006 were retrospectively analyzed.A multivariate logistic regression model was constructed to identify risk factors for the development of acute kidney injury（AKI） defined as a serum creatinine（Scr） 130 to 199 μmol/L（1.47 to 2.25 mg/dL） or Creatinine clearance（Ccr） 30 to 60 ml/min.The SPSS 11.5 software was used in all analyses.Results：It was found by the multivariate forward stepwise logistic regression analysis that the risk factors for the development of postoperative AKI following isolated CABG were EF≥50,EF≤30,pulse pressure≥60 mmHg,peripheral vascular disease,diabetes,emergent procedure,triple-vessel disease,body mass index（kg/m2）,perioperative and postoperative IABP,NYHA class Ⅲ＆IV and CPB.But EF≥50 and Perioperative and Postoperative IABP could be protective factors（OR 〈 1）.Conclusion：AKI might be the most important stage at which a positive test should increase the physician’s awareness of the presence of risk for renal injury and then preventive or therapeutic intervention could be performed when the situation is still reversible.