冠状动脉造影到心脏瓣膜手术时间间隔对术后肾功能不全的影响

Effect of time interval between coronary angiography and valvular surgery on postoperative acute kidney injury

目的评估冠状动脉造影到心脏瓣膜手术时间间隔对术后肾功能不全的影响。方法连续入选2015年5月至2016年7月于中国医学科学院阜外医院住院需行冠状动脉造影和心脏瓣膜手术的患者,按冠状动脉造影到心脏瓣膜手术时间间隔将患者分为≤48 h组和>48 h组。收集两组患者术前基线资料,手术相关资料以及术后临床结果,比较分析造影与手术的时间间隔对术后肾功能不全的影响。结果两组患者术前基线资料和手术相关资料差异无统计学意义,造影后48 h以内手术的患者发生急性肾损伤的比例较48 h以后手术的患者显著升高(38.3%比12.8%,χ~2=8.06,P=0.01)。造影后48 h以内手术的患者术后住院时间显著增加(9 d比7 d,Z=-3.08,P<0.01),术后新发心房颤动的发生率显著增高(40.4%比21.3%,χ~2=4.04,P=0.04)。结论为了减少急性肾损伤的发生率,获得更好的临床结果,建议择期瓣膜手术在冠状动脉造影48 h后实行。

Objective To assess the effect of time interval between coronary angiography and valvular surgery on postoperative acute kidney injury. Methods Patients were enrolled from May 2015 to July 2016 in Fuwai Hospital who had consequent coronary angiographies and cardiac valve surgeries.Patients were divided into the≤48 h group and the>48 h group according to coronary angiography and heart valve surgery intervals.The preoperative baseline data,operative data and postoperative clinical outcomes of two groups were collected,and the effect of time interval between angiography and operation on postoperative acute kidney injury was analyzed. Results No significant difference in preoperative baseline data and operative data between the two groups was observed.The≤48 h group had a significant higher postoperative acute kidney injury rate(38.3%vs.12.8%,χ2=8.06,P=0.01).The≤48 h group also had longer postoperative hospitalization time(9 d vs.7 d,Z=-3.08,P<0.01)and higher newly onset atrial fibrillation rate(40.4%vs.21.3%,χ2=4.04,P=0.04). Conclusions In order to reduce the acute kidney injury and obtain better clinical results,it is suggested that the elective valve surgeries be performed 48 h after coronary angiography.