中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

老年患者体外与非体外循环冠状动脉旁路移植术术后急性肾损伤的对比研究

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目的 对比研究老年患者(年龄≥70 岁)体外循环冠状动脉旁路移植术(cardiopulmonary coronary artery bypass grafting,CCABG)和非体外循环冠状动脉旁路移植术(off-pump coronary artery bypass grafting,OPCAB)对术后急性肾损伤(acute kidney injury,AKI)发生的影响。 方法 回顾分析我中心 2009 年 1 月 1 日至 2017 年 12 月 31 日接受单纯 CABG 的老年患者资料,比较 CCABG 组和 OPCAB 组术后 AKI 的发生率及严重程度情况。剔除术前接受肾脏替代治疗、肌酐值记录缺失、急诊手术及合并其他手术的病例。期间单纯 CABG 共 3 346 例,其中老年患者 1 405 例(42.0%),根据是否使用体外循环机将该组老年患者分为 CCABG 组(956 例)和 OPCAB 组(449 例)。 结果 CCABG 组 AKI 共发生 306 例(32.0%),OPCAB 组 AKI 共 138 例(30.7%),两组差异无统计意义(x2=0.174,P=0.677)。依据 AKIN 分期进一步细分,CCABG 组较 OPCAB 组分别如下:AKINⅠ期:211 例(22.1%)/93 例(20.7%);AKINⅡ期:51 例(5.3%)/23 例(5.1%);AKINⅢ期 44 例(4.6%)/22 例(4.9%),两组差异无统计意义(P=0.579,1.000,0.788)。住院期间 CCABG 组新发肾衰透析 31 例(3.2%),OPCAB 组 10 例(2.2%),两组差异无统计意义(x2=0.783,P=0.376)。 结论 老年 CABG 患者术后发生 AKI 常见,且以 AKIⅠ期为主,术后新发肾衰透析比例总体较低。OPCAB 较 CCABG,并不能显著减少老年 CABG 患者术后 AKI 的发生率及严重程度。

Objective To compare the impact of cardiopulmonary coronary artery bypass grafting (CCABG) and off-pump coronary artery bypass grafting (OPCAB) on the incidence of acute kidney injury (AKI) in the elderly patients (age≥70 years). Methods To compare the rate and severity of AKI after CCABG and OPCAB, data of the isolated CABG patients (age≥70 years) in our center from January 1, 2009 to December 31, 2017 were collected and analyzed. According to the Acute Kidney Injury Network (AKIN) criteria, the severity of AKI was compared between the two groups. The following were excluded: patients with long-term dialysis, patients with missing serum creatinine data, emergent patients or CABG combined with other cardiac procedures. Results There were 3 346 isolated CABG totally, 1 405 patients (age≥70) entered the study, including 956 in CCABG and 449 in OPCAB. AKI occurred in 306 patients in CCABG group (32.0%) and in 138 patients in OPCAB group (30.7%), there were no significant differences (x2=0.174, P=0.677). According to the AKIN criteria, the severity of AKI in CCABG vs. OPCAB was as following, AKIN stage 1: 211 (22.1%) vs. 93(20.7%); AKIN stage 2: 51(5.3%) vs. 23 (5.1%); and AKIN stage 3: 44 (4.6%) vs. 22(4.9%), there were no significant differences (P=0.579, 1.000 and 0.788). There were no significant differences of new onset of dialysis between CCABG group (31 patients, 3.2%) and OPCAB group (10 patients, 2.2%), (x2=0.783, P=0.376). Conclusion AKI is a common complication after elderly CABG patients, with AKIN stage 1 accounting for most of the patients, but postoperative renal replacement therapy was rare. Comparing to CCABG, OPCAB is not associated with a significant low rate or reduced severity of AKI in elderly patients.

关键词: 冠状动脉旁路移植术; 老年; 急性肾损伤; 体外循环; 非体外循环

Key words: Coronary artery bypass grafting; elderly; acute kidney injury; cardiopulmonary; off-pump

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