Stallwood Mark I, Grayson Antony D, Mills Keith, Scawn Nigel D
Department of Cardiothoracic Anaesthesia, Liverpool, United Kingdom.
Ann Thorac Surg. 2004 Mar;77(3):968-72. doi: 10.1016/j.athoracsur.2003.09.063.
Acute renal failure after cardiac surgery is associated with a high morbidity and mortality, particularly when associated with hemodialysis. The aim of the study was to investigate whether the use of cardiopulmonary bypass increased the risk of developing acute renal failure.
The 2199 consecutive patients undergoing isolated coronary artery bypass grafting between January 2000 and March 2002 were retrospectively analyzed. Patients with significant preoperative renal dysfunction (preoperative serum creatinine > 200 micromol/L) were excluded. A multivariate logistic regression model was constructed to identify independent risk factors for the development of acute renal failure.
In the study, 53 patients (2.4%) developed acute renal failure before hospital discharge. The crude incidences of acute renal failure for isolated coronary artery bypass grafting in the on- and off- pump groups were 2.9% and 1.4%, respectively (p = 0.031). There were 1483 patients who underwent on-pump surgery whereas 716 patients were in the off-pump group. The two groups were broadly comparable on many variables. The off-pump group were slightly younger on average (63.6 versus 64.9 years old [p = 0.017]), but had more angina class IV patients (39.5% versus 28.9% [p < 0.001]) and a greater proportion of redo surgery (4.1% versus 1.6% [p < 0.001]). The on-pump group had more patients with three-vessel disease (82.8% versus 74.3% [p < 0.001]). The logistic regression model identified use of cardiopulmonary bypass as an independent risk factor for the development of acute renal failure (odds ratio 2.64 [95% confidence intervals 1.27 to 5.45]). Other independent predictors of acute renal failure were preoperative creatinine levels, diabetes, emergency operations, increasing age, increasing body mass index, and peripheral vascular disease.
Cardiopulmonary bypass is associated with significantly increased risk of acute renal failure following isolated coronary artery bypass surgery.
心脏手术后的急性肾衰竭与高发病率和死亡率相关，尤其是与血液透析相关时。本研究的目的是调查体外循环的使用是否会增加发生急性肾衰竭的风险。
对2000年1月至2002年3月期间连续接受单纯冠状动脉搭桥手术的2199例患者进行回顾性分析。排除术前有明显肾功能不全（术前血清肌酐>200微摩尔/升）的患者。构建多因素逻辑回归模型以确定急性肾衰竭发生的独立危险因素。
在本研究中，53例患者（2.4%）在出院前发生急性肾衰竭。体外循环组和非体外循环组单纯冠状动脉搭桥手术急性肾衰竭的粗发病率分别为2.9%和1.4%（p = 0.031）。有1483例患者接受体外循环手术，而716例患者在非体外循环组。两组在许多变量上大致可比。非体外循环组平均年龄稍小（63.6岁对64.9岁[p = 0.017]），但有更多IV级心绞痛患者（39.5%对28.9%[p < 0.001]）和更高比例的再次手术患者（4.1%对1.6%[p < 0.001]）。体外循环组有更多三支血管病变患者（82.8%对74.3%[p < 0.001]）。逻辑回归模型确定体外循环的使用是急性肾衰竭发生的独立危险因素（比值比2.64[95%置信区间1.27至5.45]）。急性肾衰竭的其他独立预测因素包括术前肌酐水平、糖尿病、急诊手术、年龄增加、体重指数增加和外周血管疾病。
体外循环与单纯冠状动脉搭桥手术后急性肾衰竭风险显著增加相关。
