Singh Rana Sandip, Thingnam Shyam Kumar Singh, Mishra Anand Kumar, Verma Indu, Kumar Vikas
1 Department of Cardiothoracic and Vascular Surgery, 29751 Postgraduate Institute of Medical Education and Research , Chandigarh, India.
2 Department of Biochemistry, 29751 Postgraduate Institute of Medical Education and Research , Chandigarh, India.
Asian Cardiovasc Thorac Ann. 2017 Sep-Oct;25(7-8):504-508. doi: 10.1177/0218492317730256. Epub 2017 Aug 28.
Background Renal dysfunction is a well-recognized major complication after coronary artery bypass grafting. Off-pump coronary artery bypass theoretically appears to have less impact on renal function. We estimated preoperative and postoperative creatinine clearance as a marker of renal dysfunction in patients undergoing off-pump and on-pump coronary artery bypass. Methods Thirty patients undergoing coronary artery bypass were randomly allocated to undergo either on-pump ( n = 15) or off-pump surgery ( n = 15). The two groups had similar preoperative demographic characteristics. Serum creatinine and creatinine clearance were measured for 4 days postoperatively and the results were compared with preoperative levels. Results The rise in serum creatinine on postoperative day 1 was 0.28 mgċdL in the on-pump group and 0.22 mgċdL in the off-pump group ( p = 0.27); on postoperative day 4 it was 0.15 mgċdL and 0.10 mgċdL, respectively, ( p = 0.28). Similarly, the fall in creatinine clearance was 17.34 mLċmin in the on-pump group and 19.62 mLċmin in the off-pump group on postoperative day 1 ( p = 0.42), and 10.9 and 10.94 mLċmin, respectively, on postoperative day 4 ( p = 0.64). Conclusion Renal function is not affected by the technique of coronary artery bypass surgery, whether with or without cardiopulmonary bypass, in spite of the theoretical advantage of off-pump surgery. Our study suggests that off-pump coronary artery bypass surgery does not confer significant protection from postoperative renal dysfunction in low-risk patients, when compared with on-pump surgery.
肾功能障碍是冠状动脉旁路移植术后一种公认的主要并发症。非体外循环冠状动脉旁路移植术理论上对肾功能的影响似乎较小。我们评估了接受非体外循环和体外循环冠状动脉旁路移植术患者术前和术后的肌酐清除率，作为肾功能障碍的一个指标。
30例接受冠状动脉旁路移植术的患者被随机分为体外循环组（n = 15）和非体外循环组（n = 15）。两组术前人口统计学特征相似。术后4天测量血清肌酐和肌酐清除率，并将结果与术前水平进行比较。
体外循环组术后第1天血清肌酐升高0.28mgċdL，非体外循环组为0.22mgċdL（p = 0.27）；术后第4天分别为0.15mgċdL和0.10mgċdL（p = 0.28）。同样，体外循环组术后第1天肌酐清除率下降17.34mLċmin，非体外循环组为19.62mLċmin（p = 0.42），术后第4天分别为10.9和10.94mLċmin（p = 0.64）。
尽管非体外循环手术具有理论优势，但冠状动脉旁路移植手术技术，无论是否使用体外循环，均不影响肾功能。我们的研究表明，与体外循环手术相比，非体外循环冠状动脉旁路移植术在低风险患者中并不能显著预防术后肾功能障碍。
