西印度群岛大学医院冠状动脉搭桥术后急性肾衰竭

Acute renal failure post coronary artery bypass grafting at the University Hospital of the West Indies.

作者信息

Smith R, Scarlett M, Soyibo A K, Ramphal P, Irvine R, Barton E N

机构信息

Caribbean Institute of Nephrology, Faculty of Medical Sciences, The University of The West Indies, Kingston 7, Jamaica, West Indies.

出版信息

West Indian Med J. 2007 Jun;56(3):300-4. doi: 10.1590/s0043-31442007000300023.

DOI:10.1590/s0043-31442007000300023

PMID:18072418

Abstract

OBJECTIVES

The purpose of the study was to determine the period prevalence of acute renal failure (ARF) after coronary bypass surgery (CABG) at the University Hospital of the West Indies and to identify risk factors.

METHOD

A retrospective analysis of patients who underwent CABG during the period 1994-2004 was done. Data collected included; age, gender, weight, the presence of hypertension (HTN), diabetes mellitus (DM), hypercholesterolaemia, previous myocardial infarction (MI), blood pressure on admission, urea and creatinine one year prior to surgery, on admission for surgery and post-surgery, duration of intra-operative hypotension, duration of cardiopulmonary bypass, perfusion pressure and the perioperative medications.

RESULTS

The case notes of 62 patients (68.9%) were obtained for analysis. There were 47 (75.8%) males and 15 females (24.2%)--a 3:1 ratio. The prevalence of HTN and DM in the study sample was 78% and 72% respectively, hypercholesterolaemia was 31% and a previous MI was 29%. There were no differences based on gender. Post CABG complications were: persistent postoperative hypotension (6.8%), congestive cardiac failure (CCF) (6.8%), arrhythmia (6.8%), sepsis (6.8%), lower respiratory tract infection (LRTI) and pleural effusion (5.1%), heart block (3.4%), pulmonary embolism (1.7%), cellulitis and haematoma formation were 1.7%. Three patients had increases in postoperative creatinine values > 89 micromol/L over the postoperative value resulting in a prevalence of ARF of 5%. One of the three patients died and none received dialysis. There were no statistical difference in pre-operative clinical and biochemical characteristics based on the presence or absence of ARE. The presence of diabetes and increased length of stay were significant predictors of increasing postoperative creatinine values adjusting for pre-operative creatinine values. In addition, the presence of diabetes mellitus and male gender were significant predictors of increasing postoperative urea values.

CONCLUSION

DM is a significant risk factor for the development of ARF post CABG.

摘要

目的

本研究旨在确定西印度群岛大学医院冠状动脉搭桥手术（CABG）后急性肾衰竭（ARF）的期间患病率，并识别风险因素。

方法

对1994年至2004年期间接受CABG的患者进行回顾性分析。收集的数据包括：年龄、性别、体重、高血压（HTN）、糖尿病（DM）、高胆固醇血症、既往心肌梗死（MI）的存在情况、入院时血压、手术前一年、手术入院时及手术后的尿素和肌酐、术中低血压持续时间、体外循环持续时间、灌注压力及围手术期用药情况。

结果

获取了62例患者（68.9%）的病历进行分析。其中男性47例（75.8%），女性15例（24.2%），男女比例为3:1。研究样本中HTN和DM的患病率分别为78%和72%，高胆固醇血症为31%，既往MI为29%。基于性别无差异。CABG术后并发症包括：持续性术后低血压（6.8%）、充血性心力衰竭（CCF）（6.8%）、心律失常（6.8%）、败血症（6.8%）、下呼吸道感染（LRTI）和胸腔积液（5.1%）、心脏传导阻滞（3.4%）、肺栓塞（1.7%）、蜂窝织炎和血肿形成均为1.7%。3例患者术后肌酐值较术后基础值升高>89微摩尔/升，导致ARF患病率为5%。3例患者中有1例死亡，无人接受透析治疗。基于是否发生ARF，术前临床和生化特征无统计学差异。在校正术前肌酐值后，糖尿病的存在和住院时间延长是术后肌酐值升高的显著预测因素。此外，糖尿病的存在和男性性别是术后尿素值升高的显著预测因素。