慢性肾脏病患者行体外循环心脏手术的临床分析

Clinical analysis in patients with chronic kidney disease undergoing cardiopulmonary bypass for cardiac surgery

目的分析评价术前慢性肾脏病(CKD)对体外循环心脏术后临床结果的影响。方法收集2006年5月至2011年12月在我院择期行体外循环心脏手术的成年病例数据共2 552例,以肾小球滤过率<60 ml/(min.1.73m2)为CKD诊断标准,将患者分为CKD组和非CKD组,对两组患者临床资料进行比较分析。结果术前合并CKD者148例,患病率为5.8%。与非CKD组比较,CKD组患者合并心血管系统疾病较多,术后急性肾功能不全发生率明显升高(19.6%vs.1.8%,P<0.001),接受肾脏替代治疗比例升高(7.4%vs.0.7%,P<0.001),术后机械通气时间、ICU时间和术后住院时间延长,术后房颤和神经系统并发症发生率升高,住院期间死亡率升高(6.1%vs.1.1%,P<0.001)。Logistic分析显示,CKD分别是体外循环心脏手术后急性肾功能不全(OR 2.954,P<0.001)、肾脏替代治疗(OR 3.491,P<0.001)和死亡(OR 3.491,P=0.004)的独立危险因素。结论 CKD患者合并症多,体外循环心脏术后并发症、发生率和死亡率升高,手术风险增加;CKD是体外循环心脏手术后急性肾功能不全和肾脏替代治疗的预测因子,也是术后死亡的独立危险因素。

Objective To assess the impact of preoperative chronic kidney disease （CKD） on outcome following cardiac surgery with cardiopulmonary bypass （CPB）. Methods Prospectively collected data were analyzed on 2552 consecutive adult patients who underwent eleetive cardiac surgery with CPB from May 2006 to December 2011. Defined by estimated glomerular filtration rate （eGFR） 〈 60 ml/（ min·1.73 m2）, the patients were divided into CKD group and non- CKD group, and the clinical data were ana- lyzed. Results There were 148 preoperative CKD patients and the prevalence rate of CKD was 5.8%. Compared with Non - CKD patients, the patients with preoperative CKD were associated with an increased acute renal dysfunction （19.6% vs. 1.8%, P 〈 0. 001 ） and increased renal replacement therapy （7.4% vs. O. 7% , P 〈0. 001 ） , delayed ventilation, prolonged ICU stay and postop- erative hospital stay, increased incidence of postoperative atrial fibrillation and neurological complications and higher mortality （6.1% vs. 1.1%, P 〈 0. 001 ）. Logistic regression analysis showed that, CKD was an independent risk factor for acute renal dysfunction （ OR 2. 954, P 〈 0. 001 ）, renal replacement therapy （ OR 3. 491, P 〈 0.001 ） and death （ OR 3. 491, P = 0.004） after cardiac surgery. Conclusion There are more comorbidities before surgery and more complications after surgery in CKD patients who received cardiac surgery with CPB. CKD is a strong predictor of acute renal dysfunction and renal replacement therapy, and is also an independent risk factor for death after cardiac surgery with CPB.