Baloria Kanwar A, Pillai Biju S, Goel Sanjay, Selot Nandini
Max Devki Devi Heart and Vascular Institute, New Delhi, India.
Asian Cardiovasc Thorac Ann. 2013 Dec;21(6):649-54. doi: 10.1177/0218492312465421. Epub 2013 Jul 9.
The incidence of acute renal dysfunction has not changed much over the years, despite improvements in perioperative care. Our objectives were to evaluate the impact of timing of cardiac surgery after coronary angiography on acute renal dysfunction, to identify risk factors associated with development of acute renal dysfunction, and to measure the association between acute renal dysfunction and mortality.
The patients were divided into 3 groups: group A (cardiac surgery 0-3 days after angiography), group B (surgery 4-6 days after angiography), and group C (surgery > 6 days after angiography). Endpoints were acute renal dysfunction, defined as serum creatinine > 25% of baseline on the 3rd postoperative day, and mortality.
In 749 patients, the incidence of acute renal dysfunction was 15%; 5% required dialysis. Hypertension, congestive heart failure, chronic obstructive pulmonary disease, ejection fraction < 40%, prolonged cardiopulmonary bypass time, intraaortic balloon pump use, and urgent surgery were risk factors for acute renal dysfunction after cardiac surgery. Patients in group C had a lower risk of acute renal dysfunction.
Acute renal dysfunction has a definite relationship with the time period between angiography and cardiac surgery. The causative factors for this condition are multiple and also show a consistent association with mortality.
尽管围手术期护理有所改善，但多年来急性肾功能障碍的发生率变化不大。我们的目标是评估冠状动脉造影后心脏手术时机对急性肾功能障碍的影响，确定与急性肾功能障碍发生相关的危险因素，并衡量急性肾功能障碍与死亡率之间的关联。
患者分为3组：A组（造影后0 - 3天进行心脏手术）、B组（造影后4 - 6天进行手术）和C组（造影后>6天进行手术）。观察终点为急性肾功能障碍，定义为术后第3天血清肌酐>基线值的25%，以及死亡率。
749例患者中，急性肾功能障碍的发生率为15%；5%的患者需要透析。高血压、充血性心力衰竭、慢性阻塞性肺疾病、射血分数<40%、体外循环时间延长、使用主动脉内球囊反搏以及急诊手术是心脏手术后急性肾功能障碍的危险因素。C组患者发生急性肾功能障碍的风险较低。
急性肾功能障碍与冠状动脉造影和心脏手术之间的时间间隔有明确关系。这种情况的致病因素是多方面的，并且也与死亡率存在一致的关联。
