肾脏血流阻力指数预测冠状动脉旁路移植术后急性肾损伤

Renal Resistance Index Predicts Acute Kidney Injury After Coronary Artery Bypass Grafting

目的评估肾脏血流阻力指数(renal resistance index,RRI)预测冠状动脉旁路移植手术(coronary artery bypass grafting,CABG)患者术后急性肾损伤(acute kidney injury,AKI)的可行性与有效性。方法收集阜外医院2018年2月至2018年9月接受单纯CABG的246例患者的临床资料。应用床旁超声采集RRI,KDIGO(Kidney Disease Improving Global Outcomes)诊断标准评估患者术后7 d肾损伤情况。应用受试者工作特征曲线(receiver operating characteristic curve,ROC)下面积评估肾脏血流阻力指数这一指标预测单纯CABG患者术后急性肾损伤发生的可行性与有效性。结果研究最终收集246例患者完整的临床资料,患者平均年龄(62.0±8.0)岁,女性占29.3%,CABG术后总的AKI发生率为30.5%。其中54例(22.0%)患者符合AKI 1级标准,15例(6.1%)患者符合AKI 2级标准,6例(2.4%)患者符合AKI 3级标准。ROC曲线下面积结果显示RRI≥0.70可较好地预测CABG患者术后急性肾损伤的发生。多因素回归分析同时发现CABG患者术前左室射血分数小于50%更容易发生急性肾损伤。结论CABG术后急性肾损伤的发生率较高,RRI≥0.70预测CABG患者术后AKI发生可行有效。术前左室射血分数小于50%是CABG术后发生急性肾损伤的独立危险因素。

Objective To evaluate the feasibility and effectiveness of the renal resistance index(RRI)for predicting of acute kidney injury(AKI)in patients after the coronary artery bypass surgery(CABG).Methods From February 2018 to September 2018,246 patients undergoing isolated CABG in Fuwai Hospital were prospectively enrolled in the study.RRI was obtained by bedside kidney ultrasound and Kidney Disease Improving Global Outcomes(KDIGO)diagnostic criteria were used to evaluate renal injury 7 d after surgery.The area under the receiver operating characteristic curve(ROC)was used to evaluate the feasibility and effectiveness of RRI for postoperative AKI in patients with CABG.Results Complete clinical data of 246 patients were finally collected,the mean age of patients was(62.0±8.0)years and 29.3%were female.Of the study patients,30.5%met the criteria for AKI,54(22.0%)for AKIⅠ,15(6.1%)for AKIⅡand 6(2.4%)for AKIⅢ.Area under the ROC curve indicated that renal resistance index greater than or equal to 0.70 can better predict the occurrence of postoperative acute kidney injury in CABG patients.And multi-factor regression analysis showed preoperative left ventricular ejection fraction(LVEF)less than 50%was an independent risk factors for postoperative acute kidney injury in CABG patients.Conclusion The incidence of postoperative AKI in CABG patients is slight high.RRI greater than or equal to 0.70 is feasible to predict postoperative AKI in CABG patients.Preoperative LVEF less than 50%is an independent risk factor for AKI after CABG.