停跳冠状动脉旁路移植术后术中低血压对术后急性肾损伤、死亡率和住院时间的影响：一项单中心回顾性队列研究。
The impact of intraoperative hypotension on postoperative acute kidney injury, mortality and length of stay following off-pump coronary artery bypass grafting surgery: a single-center retrospective cohort study.
机构信息
Department of Anesthesiology, Second Affiliated Hospital of Army Medical University, PLA, No. 83 Xinqiao Road, Chongqing, 400037, China.
出版信息
BMC Anesthesiol. 2024 Jul 5;24(1):224. doi: 10.1186/s12871-024-02616-4.
BACKGROUND
Off-pump coronary artery bypass grafting (OPCABG) presents distinct hemodynamic characteristics, yet the relationship between intraoperative hypotension and short-term adverse outcomes remains clear. Our study aims to investigate association between intraoperative hypotension and postoperative acute kidney injury (AKI), mortality and length of stay in OPCABG patients.
METHODS
Retrospective data of 494 patients underwent OPCABG from January 2016 to July 2023 were collected. We analyzed the relationship between intraoperative various hypotension absolute values (MAP > 75, 65 < MAP ≤ 75, 55 < MAP ≤ 65, MAP ≤ 55 mmHg) and postoperative AKI, mortality and length of stay. Logistic regression assessed the impacts of exposure variable on AKI and postoperative mortality. Linear regression was used to analyze risk factors on the length of intensive care unit stay (ICU) and hospital stay.
RESULTS
The incidence of AKI was 31.8%, with in-hospital and 30-day mortality at 2.8% and 3.5%, respectively. Maintaining a MAP greater than or equal 65 mmHg [odds ratio (OR) 0.408; p = 0.008] and 75 mmHg (OR 0.479; p = 0.024) was significantly associated with a decrease risk of AKI compared to MAP less than 55 mmHg for at least 10 min. Prolonged hospital stays were linked to low MAP, while in-hospital mortality and 30-day mortality were not linked to IOH but exhibited correlation with a history of myocardial infarction. AKI showed correlation with length of ICU stay.
CONCLUSIONS
MAP > 65 mmHg emerges as a significant independent protective factor for AKI in OPCABG and IOH is related to length of hospital stay. Proactive intervention targeting intraoperative hypotension may provide a potential opportunity to reduce postoperative renal injury and hospital stay.
TRIAL REGISTRATION
ChiCTR2400082518. Registered 31 March 2024. https://www.chictr.org.cn/bin/project/edit?pid=225349 .
背景
非体外循环冠状动脉旁路移植术（OPCABG）呈现出独特的血液动力学特征，但术中低血压与短期不良结局之间的关系仍不明确。本研究旨在探讨 OPCABG 患者术中低血压与术后急性肾损伤（AKI）、死亡率和住院时间之间的关系。
方法
回顾性收集了 2016 年 1 月至 2023 年 7 月期间 494 例行 OPCABG 的患者数据。分析了术中各种低血压绝对值（MAP＞75mmHg、65mmHg＜MAP≤75mmHg、55mmHg＜MAP≤65mmHg、MAP≤55mmHg）与术后 AKI、死亡率和住院时间之间的关系。Logistic 回归评估了暴露变量对 AKI 和术后死亡率的影响。线性回归分析了 ICU 住院时间和住院时间的危险因素。
结果
AKI 的发生率为 31.8%，院内和 30 天死亡率分别为 2.8%和 3.5%。维持 MAP 大于或等于 65mmHg[比值比（OR）0.408；p=0.008]和 75mmHg（OR 0.479；p=0.024）与 MAP 小于 55mmHg 至少 10min 相比，发生 AKI 的风险显著降低。延长住院时间与 MAP 降低有关，而院内死亡率和 30 天死亡率与 IOH 无关，但与心肌梗死史有关。AKI 与 ICU 住院时间有关。
结论
MAP＞65mmHg 是 OPCABG 中 AKI 的一个显著独立保护因素，而 IOH 与住院时间有关。针对术中低血压的积极干预可能为降低术后肾损伤和住院时间提供潜在机会。
试验注册
ChiCTR2400082518。注册日期：2024 年 3 月 31 日。https://www.chictr.org.cn/bin/project/edit?pid=225349。
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