高危老年患者行冠状动脉搭桥术后急性肾损伤的危险因素分析

Risk factors of acute kidney injury after coronary artery bypass grafting in high-risk elderly patients

目的:分析高危老年冠心病患者行冠状动脉搭桥(CABG)术后发生急性肾损伤(AKI)的危险因素。方法:纳入560例于2013-02-2017-10在郑州大学人民医院行单纯CABG的高危老年患者,根据术后是否发生AKI分为AKI组和对照组,应用单因素和多因素Logistic回归分析影响术后AKI的因素。结果:多因素Logistic分析显示,糖尿病(OR=1.394,P=0.034)、体外循环(CPB)(OR=4.215,P<0.001)、围术期大量输血(OR=3.319,P<0.001)、术后低心排综合征(OR=1.610,P=0.021)或急性肺损伤/急性呼吸窘迫综合征(ALI/ARDS)(OR=1.771,P=0.018)是CABG术后发生AKI的危险因素,其中CPB和围术期大量输血是主要危险因素。结论:高危老年患者行CABG应尽可能避免应用CPB,减少围术期红细胞输血量,积极干预术后ALI/ARDS或低心排综合征,可减少术后AKI的发生。

Objective:To analyze risk factors of acute kidney injury (AKI) after coronary artery bypass grafting(CABG)in high-risk elderly patients with coronary heart disease (CHD).Method:A total of 560 high-risk elderly patients who accepted CABG in People’s Hospital of Zhengzhou University from February 2013 to October 2017 were selected and divided into AKI group and control group according to whether or not postoperative AKI occurred.Single factor analysis and multivariate Logistic regression analysis were used to analyze the influencing factors of postoperative AKI.Result:Multi-factor Logistic analysis showed that diabetes (OR=1.394,P=0.034),cardiopulmonary bypass (CPB) (OR=4.215,P<0.001),perioperative transfusion of large number of red blood cell(OR=3.319,P<0.001),postoperative low cardiac output syndrome (OR=1.610,P=0.021) or acute lung injury/acute respiratory distress syndrome (ALI/ARDS) (OR=1.771,P=0.018) were risk factors for AKI after CABG,among them,CPB and perioperative transfusion of large number of red blood cel were the main risk factors.Conclusion:In high-risk elderly patients undergoing CABG,CPB should be avoided as much as possible,red blood cell transfusion volume should be reduced during perioperative period,and ALI/ARDS or low cardiac output syndrome should be actively intervened to reduce the occurrence of postoperative AKI.