非体外循环冠状动脉搭桥术后低蛋白血症与补充人血白蛋白对患者急性肾损伤的影响

Effects of hypoalbuminemia and human albumin supplementation on patients with acute kidney injury after off-pump coronary artery bypass grafting

目的探讨非体外循环冠状动脉搭桥术(OPCABG)后低蛋白血症和补充人血白蛋白对患者急性肾损伤(AKI)的影响。方法回顾性分析2018年12月-2020年1月于天津市胸科医院择期行OPCABG的484例冠状动脉粥样硬化性心脏病患者的临床资料,汇总其基本资料、美国麻醉师协会分级、冠状动脉搭桥数量、术中出血量、人工胶体使用情况、术后7 d内血红蛋白最低值、术后低蛋白血症发生情况、术后入住重症加强护理病房时间、胸腔置管引流量、围术期输血量、术后人血白蛋白用量等。按是否发生AKI将所有患者分为非AKI组(414例)和AKI组(70例),比较两组患者上述指标的差异。选取组间比较P<0.1的指标,采用多因素Logistic回归分析AKI发生的危险因素;按术后是否发生低蛋白血症将所有患者分为正常蛋白组(347例)和低蛋白血症组(137例),进行分层分析以探讨补充人血白蛋白与AKI发生的相关性。结果多因素Logistic回归分析结果显示,术后低蛋白血症对AKI的影响无统计学意义(P>0.05),体质量指数、术后人血白蛋白用量均有统计学意义(P<0.05),即体质量指数每增加1个单位,AKI发生风险将增加12.7%;人血白蛋白用量每增加10 g,AKI发生风险将增加17.3%。分层分析结果显示,正常蛋白组患者术后补充人血白蛋白每增加10 g,AKI发生风险将增加26.9%;低蛋白血症组患者术后补充人血白蛋白每增加10 g,AKI发生风险将增加14.0%。结论低蛋白血症不是OPCABG后发生AKI的危险因素,但术后补充人血白蛋白是发生AKI的危险因素。

OBJECTIVE To investigate the effects of hypoalbuminemia and human albumin supplementation on patients with acute kidney injury(AKI)after off-pump coronary artery bypass grafting(OPCABG).METHODS From December 2018 to January 2020,clinical information of 484 patients with coronary atherosclerotic heart disease who underwent selective OPCABG in Tianjin Chest Hospital were analyzed retrospectively.The basic data,American Society of Anesthesiologists(ASA)grading,the number of coronary artery bypass grafting,amount of intraoperative bleeding,use of artificial colloid,minimum value of hemoglobin within 7 days after operation,hypoalbuminemia occurred after operation,monitoring time in postoperative intensive care unit,drainage volume of thoracic catheterization,perioperative blood transfusion,amount of human albumin after operation were summarized.All patients were divided into non-AKI group(414 cases)and AKI group(70 cases)according to the occurrence of AKI.The differences of the above indexes between the two groups were compared.Multiple Logistic regression analysis was performed to analyze the risk factor of AKI when selecting the indexes with P<0.1.According to whether hypoalbuminemia occurred after operation,all patients were divided into normal protein group(347 cases)and hypoalbuminemia group(137 cases).Hierarchical analysis was carried out to explore the correlation between human albumin supplementation and AKI.RESULTS The results of multiple Logistic regression analysis showed that there was no significant effect on AKI in postoperative hypoalbuminemia(P>0.05),but there were significant effect in body mass index and the dosage of postoperative human serum albumin(P<0.05).The risk of AKI would increase by 12.7%every time the body mass index increases by 1 unit;the risk of AKI increased by 17.3%for every 10 g increase in the dosage of human albumin.Stratified analysis showed that the risk of AKI would increased by 26.9%for every 10 g increase in postoperative human albumin supplementation in normal protein group and 14.0%for every 10 g increase in postoperative human albumin supplementation in hypoalbuminemia group.CONCLUSIONS Hypoalbuminemia is not a risk factor for the development of AKI after OPCABG,but human albumin supplementation is a risk factor for AKI after OPCABG.