冠脉搭桥术后急性肾损伤临床分析

A clinical analysis on acute kidney injury after coronary artery bypass graft

目的 探讨冠脉搭桥术（CABG）后急性肾损伤（AKI）的相关因素,分析AKI对患者预后的影响.方法 回顾性分析2012年1月至2013年12月河南科技大学第一附属医院227例CABG患者的临床资料,根据患者术后是否出现AKI分为AKI组和非AKI组,应用单因素分析和Logistic回归分析CABG后AKI相关因素,并分析AKI对患者预后的影响.结果 两组患者手术时间,应用主动脉内球囊反搏泵（IABP）,应用呋塞米、多巴胺、肾上腺素、硝酸甘油、米力农、胺碘酮、羟乙基淀粉及前列地尔比较,差异具有统计学意义,可能与CABG后AKI有关.经过Logistic回归分析显示,手术时间（P=0.004）,应用呋塞米（P=0.01）、肾上腺素（P=0.035）与CABG后AKI有关.AKI组患者术后机械通气时间、住ICU时间、住院时间较非AKI组长,低氧血症发生率、二次插管率高,差异具有统计学意义;而术后30 d内死亡率、心律失常发生率未见统计学差异.结论 手术时间、应用呋塞米、肾上腺素是CABG后AKI的独立危险因素.AKI患者机械通气时间、住ICU时间、住院时间均延长,低氧血症发生率、二次插管率高.

Objective To explore the related factors on acute kidney injury （AKI） after coronary artery bypass graft （CABG） and its influence on prognosis. Methods A retrospective analysis was made on the clinical data of 227 CABG patients from January 2012 to December 2013 in the First Affiliated Hospital of Henan University of Science and Technology. These subjects were divided into two groups according to whether patients with postoperative AKI： the AKI group and the NON-AKI group. The factors related to AKI following CABG were analyzed by single factor analysis and Logistic regression analysis. And the influence on the prognosis of patients with AKI were analyzed. Results The operation time, application of intraaortic balloon pump counterpulsation （IABP）, application of furosemide, dopamine, epinephrine, nitroglycerin, milrinone, amiodarone, hydroxyethyl starch and alprostadil were statistically significant difference between two groups, they may be associated with AKI after CABG. Logistic regression analysis showed that operation time（P=0.004）, furosemide（P=0.001 ）, epinephrine （P=0.035） were associated with AKI after CABG. The duration of mechanical ventilation in AK1 group, time in ICU and hospital stay were longer than the NON-AKI group. The AKI group has a significantly higher rate of hypoxemia and higher rate of re-intubation. There were no significant differences between the two groups in the death rate within 30 days of hospital stay and the occurrence rate of arrhythmia. Conclusion The operation time, furosemide, epinephrine are independent risk factors for the occurrence of AKI after CABG. The duration of mechanical ventilation, time in ICU and hospital stay, as well as the rate of hypoxemia and re-intubation in AKI patients are high