Zhou Jia-Yi, Liu Xiao-Cheng, Yang Qin, He Guo-Wei
The Institute of Cardiovascular Diseases and Department of Cardiovascular Surgery, TEDA International Cardiovascular Hospital, Tianjin University & Chinese Academy of Medical Sciences, Tianjin, China.
Department of Surgery, Oregon Health and Science University, Portland, Oregon, USA.
J Card Surg. 2022 Dec;37(12):4891-4898. doi: 10.1111/jocs.17164. Epub 2022 Nov 15.
Acute renal failure (ARF) is one of the major complications after coronary artery bypass grafting (CABG) surgery. The risk factors are changing along with the technical evolution. The aim of this study was to identify the risk factors for ARF requiring dialysis after CABG surgery in the current era.
Between April 2012 and November 2019, 5077 consecutive patients who underwent CABG were analyzed retrospectively. The patients were divided into ARF group and non-ARF group according to whether ARF occurred and dialysis was required after operation. Univariate analysis was performed to find possible factors associated with ARF. Any variables that had trends to be associated with ARF were included in stepwise multiple logistic regression analysis.
Of the 5077 patients who underwent CABG, 53 (1.04%) developed ARF requiring dialysis whereas 5024 (98.96%) were in non-ARF group. Cardiopulmonary bypass (CPB) time (odds ratio [OR], 1.009; 95% confidence interval [CI], 1.003-1.016; p = .006), insertion of intra-aortic balloon pump (IABP; OR, 19.294; 95% CI, 5.49-67.808; p = .000), and low ejection fraction (EF; OR, 0.943; 95% CI, 0.894-0.994; p = .030) were independent risk factors for development of ARF requiring dialysis in patients undergoing CABG surgery.
Our study identified prolonged CPB time, insertion of IABP, and low EF as independent risk factors for developing ARF requiring dialysis after CABG. The results suggest that shortening of CPB time and protection of cardiac function are important factors to prevent ARF and that special care should be taken to protect the renal function when the patient need insertion of IABP.
急性肾衰竭（ARF）是冠状动脉旁路移植术（CABG）后主要的并发症之一。随着技术的发展，危险因素也在发生变化。本研究的目的是确定当前时代CABG术后需要透析的ARF的危险因素。
回顾性分析2012年4月至2019年11月期间连续5077例行CABG的患者。根据术后是否发生ARF及是否需要透析，将患者分为ARF组和非ARF组。进行单因素分析以找出与ARF相关的可能因素。任何有与ARF相关趋势的变量都纳入逐步多元逻辑回归分析。
在5077例行CABG的患者中，53例（1.04%）发生需要透析的ARF，而5024例（98.96%）在非ARF组。体外循环（CPB）时间（比值比[OR]，1.009；95%置信区间[CI]，1.003 - 1.016；p = 0.006）、主动脉内球囊反搏（IABP）置入（OR，19.294；95% CI，5.49 - 67.808；p = 0.000）和低射血分数（EF；OR，0.943；95% CI，0.894 - 0.994；p = 0.030）是CABG手术患者发生需要透析的ARF的独立危险因素。
我们的研究确定CPB时间延长、IABP置入和低EF是CABG术后发生需要透析的ARF的独立危险因素。结果表明，缩短CPB时间和保护心功能是预防ARF的重要因素，当患者需要置入IABP时应特别注意保护肾功能。
