冠脉造影到心脏瓣膜手术时间间隔与术后急性肾损伤发生的关系

Relationship between the time interval from coronary angiography to heart valve surgery and the occurrence of postoperative acute kidney injury

目的 分析冠脉造影到心脏瓣膜手术时间间隔与术后急性肾损伤(AKI)发生的关系。方法 将我院收治的86例行冠脉造影和心脏瓣膜手术的患者根据冠脉造影到心脏瓣膜手术时间间隔分为对照组(n=43,冠脉造影到心脏瓣膜手术时间间隔≤48 h)和试验组(n=43,冠脉造影到心脏瓣膜手术时间间隔>48 h)。比较两组术前、术中及术后相关指标,分析冠脉造影到心脏瓣膜手术时间间隔对AKI发生的影响。结果 试验组体外循环患者占比及体外循环期间红细胞压积(Hct)低于对照组,体外循环时间短于对照组(P<0.05)。试验组术后12 h的肾损伤分子-1(KIM-1)、白细胞介素-18(IL-18)水平、术后7 d的肌酐、胱抑素C水平及连续性肾脏替代疗法(CRRT)、AKI患者占比低于对照组,住院时间短于对照组(P<0.05)。结论 于冠脉造影48 h后行心脏瓣膜手术能够降低术后AKI发生风险,获得较为肯定的治疗效果。

Objective To analyze the relationship between the time interval from coronary angiography to heart valve surgery and the occurrence of postoperative acute kidney injury(AKI).Methods A total of 86 patients with coronary angiography and heart valve surgery admitted in our hospital were divided into control group(n=43,the time interval from coronary angiography to heart valve surgery ≤48 h) and experimental group(n =43,the time interval from coronary angiography to heart valve surgery>48 h) according to the time interval from coronary angiography to heart valve surgery.The related indexes before,during and after operation were compared between the two groups,and the influence of the time interval from coronary angiography to heart valve surgery on AKI was analyzed.Results The proportion of patients with cardiopulmonary bypass and hematocrit(Hct) during cardiopulmonary bypass in the experimental group were lower than those in the control group,and the cardiopulmonary bypass time was shorter than that in the control group(P<0.05).The levels of kidney injury molecule-1(KIM-1),interleukin-18(IL-18) at 12 h after operation,creatinine and cystatin C at 7 d after operation,the proportion of patients with continuous renal replacement therapy(CRRT) and AKI in the experimental group were lower than those in the control group,and the hospital stay was shorter than that in the control group(P<0.05).Conclusion Heart valve surgery after 48 h of coronary angiography can reduce the risk of postoperative AKI and obtain a relatively positive therapeutic effect.