Ali Taimur Asif, Salahuddin Urooj, Shoukat Arfeel, Shahzad Noman, Naeem Syed Saad, Dar Mudassir Iqbal, Fatimi Saulat Hasnain
Section of Cardiothoracic Surgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan.
Department of Cardiac Surgery, Civil Hospital Karachi, Karachi, Pakistan.
Asian Cardiovasc Thorac Ann. 2016 Sep;24(7):653-7. doi: 10.1177/0218492316658375. Epub 2016 Jul 27.
The effect of diabetes mellitus on morbidity and mortality in patients undergoing coronary artery bypass grafting has remained uncertain, and conflicting conclusions have been reported in clinical trials. Evidence suggests that coronary artery bypass in patients with diabetes mellitus carries a higher risk of stroke, renal failure, perioperative complications, and sternal wound infection. This study evaluated the frequency of acute renal dysfunction after coronary artery bypass in diabetic patients, and the associated risk factors.
This cross-sectional observational study included 135 patients with diabetes (111 males and 24 females with a mean age 51 years and a body mass index of 27.44 kg m(-2)), who underwent elective coronary artery bypass from March 2015 to October 2015. Data were collected prospectively in 2 tertiary care centers. Renal dysfunction was assessed by serum creatinine levels preoperatively and at 24 and 48 h postoperatively.
Fifteen percent of patients were found to have postoperative renal dysfunction. Univariate analysis revealed that patients with increased serum creatinine preoperatively were at greater risk of developing renal dysfunction after coronary artery bypass (p = 0.00). On multivariable binary logistic regression analysis, preoperative serum creatinine level was the only independent predictor of postoperative renal dysfunction; age, body mass index, dyslipidemia, hypertension, cardiopulmonary bypass time, and aortic crossclamp time showed no significant association.
Diabetic patients with increased serum creatinine preoperatively are at greater risk of kidney damage postoperatively; therefore, these patients should be monitored and treated critically in the perioperative period.
糖尿病对接受冠状动脉搭桥手术患者的发病率和死亡率的影响仍不明确，临床试验中也报告了相互矛盾的结论。有证据表明，糖尿病患者进行冠状动脉搭桥手术时发生中风、肾衰竭、围手术期并发症和胸骨伤口感染的风险更高。本研究评估了糖尿病患者冠状动脉搭桥术后急性肾功能不全的发生率及其相关危险因素。
这项横断面观察性研究纳入了135例糖尿病患者（111例男性和24例女性，平均年龄51岁，体重指数为27.44kg/m²），这些患者于2015年3月至2015年10月接受了择期冠状动脉搭桥手术。数据在2个三级医疗中心前瞻性收集。通过术前及术后24小时和48小时的血清肌酐水平评估肾功能不全情况。
发现15%的患者术后出现肾功能不全。单因素分析显示，术前血清肌酐升高的患者冠状动脉搭桥术后发生肾功能不全的风险更高（p = 0.00）。多变量二元逻辑回归分析显示，术前血清肌酐水平是术后肾功能不全的唯一独立预测因素；年龄、体重指数、血脂异常、高血压、体外循环时间和主动脉阻断时间均无显著相关性。
术前血清肌酐升高的糖尿病患者术后发生肾损伤的风险更高；因此，这些患者在围手术期应进行密切监测和积极治疗。
