心脏手术后非体外循环与体外循环冠状动脉搭桥术的肾功能：使用Cockcroft-Gault公式估算肌酐清除率的分析

Renal function after cardiac surgery off- versus on-pump coronary artery bypass: analysis using the Cockroft-Gault formula for estimating creatinine clearance.

作者信息

Asimakopoulos George, Karagounis A Paul, Valencia Oswaldo, Alexander Nicholas, Howlader Mohamed, Sarsam Mazin A, Chandrasekaran Venkatachalam

机构信息

Department of Cardiothoracic Surgery, St. George's Hospital, London, United Kingdom.

出版信息

Ann Thorac Surg. 2005 Jun;79(6):2024-31. doi: 10.1016/j.athoracsur.2004.12.020.

DOI:10.1016/j.athoracsur.2004.12.020

PMID:15919303

Abstract

BACKGROUND

Cardiopulmonary bypass (CPB) is often associated with renal dysfunction, as measured by plasma creatinine levels and hemodialysis rates. This study compared creatinine clearance (CrCl), estimated with the Cockroft and Gault formula, between patients undergoing off-pump coronary artery bypass grafting (OPCAB) versus on-pump CABG (on-CAB).

METHODS

Data of 704 consecutive patients were analyzed. Of these patients, 404 underwent OPCAB while 300 had on-CAB. Creatinine clearance, plasma creatinine levels, and clinical outcome were compared between groups. Data between patients who developed new renal impairment, compared to patients with normal postoperative renal function, were also analyzed.

RESULTS

Creatinine clearance (preoperative, 74 +/- 25 vs 78 +/- 29 mL/min; day 1, 74 +/- 26 vs 76 +/- 31 mL/min; day 4, 70 +/- 26 vs 72 +/- 29 mL/min) and creatinine levels (preoperative, 99 +/- 25 vs 95 +/- 27 micromol/L; day 1, 101 +/- 29 vs 104 +/- 35 micromol/L; day 4, 110 +/- 44 vs 113 +/- 60 micromol/L), as well as postoperative complications (stroke 1% vs 1%; hemofiltration 1.5% vs 3.7%; death 1.2% vs 2.3%), were overall similar between OPCAB and on-CAB patients. Patients with preoperative CrCl less than 50 mL/min had higher creatinine levels in the on-CAB group on day 1 (p = 0.026), although CrCl was similar between groups. Development of new CrCl less than 50 mL/min postoperatively was associated with higher rates of intraaortic balloon pump insertion, re-sternotomy, hemofiltration, intensive care and hospital stay, without difference between groups. Female sex, low body mass index, high preoperative creatinine levels, and advanced age were associated with deterioration in CrCl.

CONCLUSIONS

Currently, the rate of renal impairment is low after both OPCAB and on-CAB. No significant difference in CrCl could be demonstrated between groups. Deterioration in renal function is associated with higher rates of postoperative complications.

摘要

背景

体外循环（CPB）常与肾功能障碍相关，可通过血浆肌酐水平和血液透析率来衡量。本研究比较了非体外循环冠状动脉搭桥术（OPCAB）患者与体外循环冠状动脉搭桥术（on-CAB）患者使用Cockcroft和Gault公式估算的肌酐清除率（CrCl）。

方法

分析了704例连续患者的数据。其中，404例行OPCAB，300例行on-CAB。比较了两组之间的肌酐清除率、血浆肌酐水平和临床结局。还分析了出现新的肾功能损害的患者与术后肾功能正常的患者之间的数据。

结果

OPCAB组和on-CAB组患者的肌酐清除率（术前，74±25对78±29 mL/min；第1天，74±26对76±31 mL/min；第4天，70±26对72±29 mL/min）、肌酐水平（术前，99±25对95±27 μmol/L；第1天，101±29对104±35 μmol/L；第4天，110±44对113±60 μmol/L）以及术后并发症（中风1%对1%；血液滤过1.5%对3.7%；死亡1.2%对2.3%）总体相似。术前CrCl低于50 mL/min的患者在第1天on-CAB组的肌酐水平较高（p = 0.026），尽管两组之间的CrCl相似。术后新出现CrCl低于50 mL/min与主动脉内球囊泵置入、再次开胸、血液滤过、重症监护和住院时间延长的发生率较高相关，两组之间无差异。女性、低体重指数、术前肌酐水平高和高龄与CrCl恶化相关。