成人心脏手术围体外循环期肾损害因素分析

Risk factors analysis of postoperative renal injury in patients undergoing cardiopulmonary bypass

目的分析围体外循环期各临床因素对成人心内直视术后肾功能的影响。方法术前肾功能正常且无肾脏疾病、无高血压、无动脉粥样硬化、无糖尿病的心内直视术成人患者158例,在术前,术后24小时检测血清肌酐,并于术中及术后持续监测有创动脉血压,于术后统计每小时尿量。对围体外循环期相关的10个参数进行单因素方差分析,包括高龄、性别、术前心力衰竭病史、病种、氧合器种类、停跳液种类、体外循环期间低灌注压、体外循环时间、术后有无血红蛋白尿及有无术后低血压;对单因素分析中有统计学意义的参数再进行多因素Logistic回归分析。结果高龄、术前心衰病史、术中低灌注压、体外循环时间及术后低血压等5个因素有统计学意义。多因素Logistic回归分析提示,术前心衰病史、体外循环时间、术后低血压是体外循环后造成肾功能损伤的独立性危险因素(P<0.05)。结论体外循环有可能造成患者术后肾功能损害,术前心衰病史、术后低血压及体外循环时间是术后肾功能损伤的高危因素。

Objective To analyse the clinical factors damaging the perioperative renal function of patients undergoing cardiopulmonary bypass.Methods 158 patients undergoing open heart surgery with normal preoperative renal function were included in our cardiopulmonary bypass group,they all had no history of kidney diseases, hypertention, athrosclerosis and diabetes mellitus.Serum creatinine was examined at 24 hours after operation;invasive arterial blood pressure was monitored continously during and after operation;hourly urine volume was also measured postoperatively.Ten variables were analyzed by univariate analysis,which including advanced age,sex,preoperative congestive heart failure, type of surgery, different oxygenators, different kinds of cardioplegic solution, low mean perfusion pressure during cardiopulmonary bypass, postoperative hemoglobinuria,prolonged cardiopumonary bypass time and postoperative hypotention.Significant variables（P＆lt;0.05） associated with renal dysfunction were included in stepwise multiple logistic regression analyses following.Results Significant variables for renal injuries after open heart sugery were advanced age,preoperative heart failure, low mean perfusion pressure,prolonged cardiopulmonary bypass time and postoperative hypotension.Prolonged cardiopulmonary bypass time, preoperative heart failure and postoperative hypotension were regarded as independent risk factors for development of renal dysfunction after open heart surgery.Conclusion Cardiopumonary bypass may cause renal injury postoperatively.The independent risk factors for development of renal dysfunction after open heart surgery are： prolonged cardiopulmonary bypass time,preoperative heart failure and postoperative hypotension.