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肾脏病与透析肾移植杂志

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冠状动脉旁路移植术后急性肾损伤影响因素及预后

  

  • 出版日期:2020-04-28 发布日期:2020-05-08

Risk factor and prognosis of acute kidney injury after coronary artery bypass grafting

  • Online:2020-04-28 Published:2020-05-08

摘要: 目的:分析冠状动脉旁路移植术(CABG)后急性肾损伤(AKI)发生的危险因素。
方法:回顾性分析1 449例择期行CABG患者的临床资料,分析发生AKI的可能相关危险因素。
结果:1 449例患者中,132例发生AKI(91%),AKI组术后30d死亡25例(189%),显著高于非AKI组的死亡率(02%)。Logistic回归分析显示:术后肺炎(OR=4557 95%CI 2186~9499)、呼吸机应用>36h (OR=3953 95%CI 2316~6748)、二次气管插管(OR=4038 95%CI 1455~11202) 、切口感染(OR=5605 95%CI 2354~13345)、体外循环时间(CPB)>2h(OR=1754 95%CI 1115~2759) (P<005)是CABG术后AKI发生的独立危险因素。
结论:CABG术后AKI显著增加术后30d死亡率,其独立危险因素包括CPB和呼吸机时间长、术后并发肺炎和切口感染等,临床上应积极采取针对措施以期改善预后。

关键词: 冠状动脉旁路移植术, 急性肾损伤, 死亡率, 危险因素

Abstract: Objective:To analyze risk factor and prognosis of acute kidney injury(AKI) after coronary artery bypass grafting(CABG).
Methodology:Clinical data of 1 449 patients under went CABG were analyzed retrospectively.The risk factors of AKI were analyzed by logistic regression.
Results:There were 132 cases (91%) met the criteria of AKI after CABG,25 cases (189%) of them died within 30 days after the operation,the mortality was significantly higher than those without AKI(02%).Logistic regression analysis showed that,postoperative pneumonia (OR=4557,95% CI 21869499),ventilator application time >36h (OR=3953,95% CI  23166748),reintubation (OR=4038,95% CI 145511202),incision infection (OR=5605,95% CI 235413345),cardiopulmonary bypass time>2h (OR=1754,95% CI  11152759) (P<005) were independent risk factors for AKI after CABG.
Conclusion:
AKI after CABG significantly increase the mortality of patients,independent risk factor of AKI  includes CPB and ventilator time,postoperative pneumonia and incision infection.

Key words: coronary artery bypass grafting, acute kidney injury, mortality, risk factors