Chan Ming-Jen, Lee Cheng-Chia, Chen Shao-Wei, Tsai Feng-Chun, Lin Pyng-Jing, Fan Pei-Chun, Hsu Hsiang-Hao, Chang Ming-Yang, Chen Yung-Chang, Chang Chih-Hsiang
Kidney Research Center, Department of Nephrology Department of Cardiothoracic and Vascular Surgery Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan City, Taiwan, R.O.C.
Medicine (Baltimore). 2017 Nov;96(45):e8395. doi: 10.1097/MD.0000000000008395.
Acute kidney injury (AKI) after coronary artery bypass grafting (CABG) is associated with a less favorable outcome. Off-pump surgery results in lower kidney dysfunction than conventional on-pump arrest surgery. On-pump arrest surgery results in a lower revascularization rate compared with off-pump surgery. On-pump beating heart (OPBH) CABG combines the advantages of beating heart surgery and cardiopulmonary bypass. This study compared the renal outcomes of 3 cardiac surgical methods. From January 2010 to December 2012, 373 patients who underwent on-pump CABG were enrolled. Propensity analysis was performed to compare the postoperative outcomes of postoperative AKI, renal replacement therapy (RRT), intensive care unit (ICU) stay, mortality, and extubating time. In total, 98 patients received conventional on-pump surgery, 160 received OPBH surgery, and 115 received off-pump surgery. The Society of Thoracic Surgeons scores of these 3 groups were 6.1 ± 13.6, 7.4 ± 13.6, and 5.6 ± 10.9, respectively. Propensity analysis revealed lower AKI incidence in the off-pump group than in the on-pump surgery group. No substantial differences were observed in mortality, RRT, and the ICU stay between the off-pump and OPBH surgery groups. Among the 3 surgical methods, off-pump surgery results in lower AKI incidence. The short-term outcome, including kidney function, of OPBH surgery is similar to that of the off-pump group. Therefore, OPBH surgery is a considerable choice for patients with a high surgical risk.
冠状动脉搭桥术（CABG）后发生的急性肾损伤（AKI）与预后较差相关。非体外循环手术导致的肾功能障碍低于传统的体外循环停跳手术。与非体外循环手术相比，体外循环停跳手术的血管再通率较低。体外循环心脏不停跳（OPBH）冠状动脉搭桥术结合了心脏不停跳手术和体外循环的优点。本研究比较了三种心脏手术方法的肾脏预后。2010年1月至2012年12月，纳入373例行体外循环冠状动脉搭桥术的患者。进行倾向分析以比较术后急性肾损伤、肾脏替代治疗（RRT）、重症监护病房（ICU）住院时间、死亡率和拔管时间的术后结果。总共98例患者接受传统体外循环手术，160例接受OPBH手术，115例接受非体外循环手术。这三组的胸外科医师协会评分分别为6.1±13.6、7.4±13.6和5.6±10.9。倾向分析显示非体外循环组的急性肾损伤发生率低于体外循环手术组。非体外循环手术组和OPBH手术组在死亡率、RRT和ICU住院时间方面未观察到实质性差异。在这三种手术方法中，非体外循环手术导致的急性肾损伤发生率较低。OPBH手术的短期结果，包括肾功能，与非体外循环组相似。因此，OPBH手术是手术风险高的患者的一个相当不错的选择。
