Bucerius Jan, Gummert Jan F, Walther Thomas, Schmitt Dierk V, Doll Nicolas, Falk Volkmar, Mohr Friedrich W
Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany.
Ann Thorac Surg. 2004 Apr;77(4):1250-6. doi: 10.1016/S0003-4975(03)01346-8.
Despite refinements in perioperative patient management postoperative renal failure requiring hemofiltration or dialysis is still a common complication after coronary artery bypass grafting associated with impaired patient outcome.
Prospective data on 9,631 patients receiving myocardial revascularization with (coronary artery bypass grafting [n = 8,870]) or without cardiopulmonary bypass (off-pump coronary artery bypass grafting [n = 761]) between April 1996 and August 2001 were evaluated by univariate and multivariate logistic regression analysis.
Overall prevalence of postoperative continuous renal replacement therapy was 4.1% (coronary artery bypass grafting, 4.3%; off-pump coronary artery bypass grafting, 1.8%; p = 0.001). Thirty of 40 selected preoperative and intraoperative patient and treatment related variables had a high association with the requirement for postoperative renal replacement therapy; fifteen of these variables were independent predictors in the whole study population. Off-pump coronary artery bypass surgery was identified as having a significantly lower predictive value for postoperative continuous renal placement therapy. In the subgroup of patients undergoing off-pump coronary artery bypass grafting surgery, a second multivariate logistic regression model revealed preoperative cardiogenic shock, urgent operation, intraoperative low cardiac output, and high transfusion requirement as independent predictors for postoperative renal replacement therapy.
Patients with preoperative nondialysis dependent renal insufficiency are at a high risk for further decline in renal function requiring postoperative continuous renal replacement therapy. Off-pump coronary artery bypass surgery is associated with a lower prevalence of postoperative renal replacement therapy after coronary artery bypass grafting.
尽管围手术期患者管理有所改进，但冠状动脉搭桥术后需要血液滤过或透析的术后肾衰竭仍是常见并发症，且与患者预后不良相关。
对1996年4月至2001年8月期间接受心肌血运重建的9631例患者的前瞻性数据进行评估，其中接受冠状动脉搭桥术（n = 8870）或非体外循环冠状动脉搭桥术（n = 761），采用单因素和多因素逻辑回归分析。
术后持续肾脏替代治疗的总体患病率为4.1%（冠状动脉搭桥术为4.3%；非体外循环冠状动脉搭桥术为1.8%；p = 0.001）。40个选定的术前和术中患者及治疗相关变量中有30个与术后肾脏替代治疗的需求高度相关；其中15个变量是整个研究人群的独立预测因素。非体外循环冠状动脉搭桥手术被确定为对术后持续肾脏替代治疗的预测价值显著较低。在接受非体外循环冠状动脉搭桥术的患者亚组中，第二个多因素逻辑回归模型显示术前心源性休克、急诊手术、术中低心输出量和高输血需求是术后肾脏替代治疗的独立预测因素。
术前非透析依赖型肾功能不全患者术后肾功能进一步下降并需要持续肾脏替代治疗的风险很高。非体外循环冠状动脉搭桥手术与冠状动脉搭桥术后较低的术后肾脏替代治疗患病率相关。
