体外和非体外循环冠脉搭桥术后老年患者肝肾功能变化

Changes of Liver and Renal Function in Elderly Patients after Conventional on-pump and off-pump Coronary Artery Bypass Grafting

目的:分析常规体外循环冠状动脉搭桥术(CPBCABG)和非体外循环冠状动脉搭桥术(OPCABG)对60岁以上老年患者肝肾功能的变化及意义。方法:根据患者意愿及病情匹配原则将390例60岁以上患者分为常规体外循环下冠状动脉搭桥术组(CPBCABG组)(290例)和非体外循环下冠状动脉搭桥术组(OPCABG组)(100例)。所有患者术前肝肾功能均正常,无严重急性肝、肾功能不全。两组患者在年龄、性别、身体质量指数、体表面积、术前射血分数、术前肝肾功能及手术危险因素等方面无明显差异。两组患者分别于术前第三天和术后第三天抽血测定丙氨酸氨基转移酶(ALT),天冬氨酸转氨酶(AST),肌酐(CR)及尿素氮(BUN)值评价患者肝肾功能。结果:390例患者均进入结果分析。OPCABG组患者术后第3天ALT、AST、CR、BUN明显低于CPBCABG组,差异比较有显著性意义(P<0.05)。结论:冠状动脉搭桥术对肝肾功能均有一定的损害,由于非体外循环冠状动脉搭桥术避免了体外循环对肝肾功能的影响,因此对肝肾功能的损害较轻,减少了术后肝肾功能不全发生的机率。

Objective： To analyze the postoperative changes of liver and renal function in elderly patients aged over 60 between on-pump coronary artery bypass grafting （CPBCABG） and off-pump coronary artery bypass grafting （OPCABG）. Methods： 390 patients aged over 60 were allocated to either on-pump coronary artery bypass grafting group （CPBCABG group）（n=290）or off-pump coronary artery bypass grafting group （OPCABG group）（n=100） according to patient＇s intention and condition. All patients were normal renal function preoperatively, no severe acute liver and renal insufficiency. No significant difference was detected in age, gender, body mass index, body surface area, preoperative ejection fraction, preoperative renal function and operation risk factors and so no between both groups （P〉0.05）. Alanine aminotransferase （ALT）, aspartate aminotransferase （AST）, creatinine （Cr） and blood urea nitrogen （BUN） were respectively measured in patients of both groups in three days before and after surgery to evaluate patients liver and renal function. Results： A total of 390 patients were involved in the final analysis. Serum ALT and AST,CR,BUN levels in the OPCABG group were significantly lower than those in the CPBCABG group at 3 day after surgery （P〈0.05）. Conclusions： CABG has an adverse effect on liver and renal function. Because of avoiding the effects of cardiopulmonary bypass on liver and renal function, OPCABG has the less adverse effect on liver and renal function and reduce the probability of liver and renal function dysfunction.