Ascione R, Lloyd C T, Underwood M J, Gomes W J, Angelini G D
Bristol Heart Institute, Bristol Royal Infirmary, United Kingdom.
Ann Thorac Surg. 1999 Aug;68(2):493-8. doi: 10.1016/s0003-4975(99)00566-4.
Coronary revascularization with cardiopulmonary bypass has the potential risk of renal dysfunction related to the nonphysiologic nature of cardiopulmonary bypass. Recently, there has been a revival of interest in performing myocardial revascularization on the beating heart and we investigated whether this prevents renal compromise.
A prospective, randomized, controlled trial was performed in 50 patients (45 males, mean age 61+/-3.7 years) undergoing elective coronary artery bypass grafting. Patients were randomly assigned to conventional revascularization with cardiopulmonary bypass (on pump) or beating heart revascularization (off pump). Glomerular and tubular function were assessed up to 48 hours postoperatively.
There were no deaths, myocardial infarctions or acute renal failure in either group. Glomerular filtration as assessed by creatinine clearance and the urinary microalbumin/creatinine ratio was significantly worse in the on pump group (p < 0.0004 and 0.0083, respectively). Renal tubular function was also impaired in the on pump group as assessed by increased N-acetyl glucosaminidase activity (p < 0.0272).
These results suggest that off pump coronary revascularization offers a superior renal protection when compared with conventional coronary revascularization with cardiopulmonary bypass and cardioplegic arrest in first time coronary bypass patients.
体外循环下冠状动脉血运重建术存在与体外循环非生理性本质相关的肾功能障碍潜在风险。近来，对在跳动心脏上进行心肌血运重建术的兴趣再度兴起，我们研究了这是否能预防肾功能损害。
对50例（45例男性，平均年龄61±3.7岁）择期冠状动脉搭桥手术患者进行了一项前瞻性、随机、对照试验。患者被随机分配接受体外循环下的传统血运重建术（体外循环）或跳动心脏血运重建术（非体外循环）。术后48小时内评估肾小球和肾小管功能。
两组均无死亡、心肌梗死或急性肾衰竭发生。通过肌酐清除率和尿微量白蛋白/肌酐比值评估的肾小球滤过功能在体外循环组明显更差（分别为p<0.0004和0.0083）。通过N-乙酰氨基葡萄糖苷酶活性增加评估，体外循环组的肾小管功能也受损（p<0.0272）。
这些结果表明，对于首次进行冠状动脉搭桥手术的患者，与体外循环和心脏停搏的传统冠状动脉血运重建术相比，非体外循环冠状动脉血运重建术提供了更好的肾脏保护。
