Litmathe J, Kurt M, Feindt P, Gams E, Boeken U
Department of Thoracic- and Cardiovascular Surgery, Heinrich-Heine University, Duesseldorf, Germany.
Thorac Cardiovasc Surg. 2009 Dec;57(8):460-3. doi: 10.1055/s-0029-1185877.
Acute changes in renal function after elective coronary bypass surgery represent a challenging clinical problem. In this study, we evaluated perioperative risk factors for the development of postoperative renal dysfunction (PRD), and the impact of such an event on the perioperative course. Additionally, we investigated the influence of preoperatively mildly increased serum creatinine on perioperative mortality and morbidity.
We retrospectively analyzed data of 2511 patients undergoing isolated CABG between 2004 and 2007 with a preoperative serum creatinine < or = 2.2 mg/dL. There were 592 patients with a preoperative serum creatinine of between 1.4 and 2.2 mg/dl (mild renal dysfunction group) and 1919 patients with a serum creatinine < 1.4 mg/dl. Perioperative risk factors for PRD were analyzed by multivariate regression analysis.
Global in-hospital mortality was 3.1 %.The incidence of PRD was 6.2 %. Mortality for patients who had PRD was 7.8 vs. 2.9 % for patients who did not ( P < 0.05). PRD increased the length of hospital stay by 3.7 days (12.2 vs. 15.9; P < 0.05). Multivariate logistic regression identified the following variables as independent predictors of PRD: age, angina class III/IV, diabetes mellitus, prolonged cardiopulmonary bypass time, and preoperative serum creatinine. With regard to preoperative renal function, we found that operative mortality was higher in the mild renal dysfunction group (5.7 % vs. 2.5 %; P < 0.05). New dialysis/hemofiltration (5.1 % vs. 1.2 %; P < 0.05) and postoperative stroke (5.1 % vs. 1.6 %; P < 0.05) were also more common in these patients.
Mild renal dysfunction preoperatively is an important predictor of outcome after CABG. In these patients, PRD dramatically increases mortality, morbidity and length of hospital stay.
择期冠状动脉搭桥手术后肾功能的急性变化是一个具有挑战性的临床问题。在本研究中，我们评估了术后肾功能不全（PRD）发生的围手术期危险因素，以及该事件对围手术期过程的影响。此外，我们还研究了术前血清肌酐轻度升高对围手术期死亡率和发病率的影响。
我们回顾性分析了2004年至2007年间2511例接受单纯冠状动脉旁路移植术（CABG）且术前血清肌酐≤2.2mg/dL患者的数据。其中592例患者术前血清肌酐在1.4至2.2mg/dL之间（轻度肾功能不全组），1919例患者血清肌酐<1.4mg/dL。通过多因素回归分析PRD的围手术期危险因素。
总体住院死亡率为3.1%。PRD的发生率为6.2%。发生PRD的患者死亡率为7.8%，未发生PRD的患者死亡率为2.9%（P<0.05）。PRD使住院时间延长3.7天（12.2天对15.9天；P<0.05）。多因素逻辑回归确定以下变量为PRD的独立预测因素：年龄、III/IV级心绞痛、糖尿病、体外循环时间延长和术前血清肌酐。关于术前肾功能，我们发现轻度肾功能不全组的手术死亡率较高（5.7%对2.5%；P<0.05）。这些患者中，新的透析/血液滤过（5.1%对1.2%；P<0.05）和术后中风（5.1%对1.6%；P<0.05）也更常见。
术前轻度肾功能不全是冠状动脉搭桥术后预后的重要预测因素。在这些患者中，PRD显著增加死亡率、发病率和住院时间。
