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单纯冠状动脉搭桥手术后的急性肾损伤

Acute Kidney Injury after Isolated Coronary Bypass Surgery.

作者信息

Slaughter John C, Davenport Daniel L, Saha Sibu P

机构信息

University of Kentucky College of Medicine, Lexington, Kentucky.

Division of Healthcare Outcomes and Optimal Patient Services, University of Kentucky, Lexington, Kentucky.

出版信息

Int J Angiol. 2024 Oct 7;34(1):51-55. doi: 10.1055/s-0044-1791545. eCollection 2025 Mar.

Abstract

Acute kidney injury (AKI) is among the most serious of the common postoperative complications of cardiac surgeries, which can increase the short- and long-term morbidity and mortality of patients. This study aimed to examine possible risk factors that lead to AKI. We sought to compare our AKI rates to national averages in coronary artery bypass grafting (CABG) reported by the Society of Thoracic Surgeons (STS). We reviewed our institution's data for renal failure in CABG procedures performed between January 1, 2020, and June 30, 2023. From the database, we identified 1,068 CABG patients and reviewed demographics, nonmodifiable conditions, and modifiable risk factors. The STS database uses the Risk, Injury, Failure, Loss, and End-stage renal disease definition for renal failure. Of our patient sample, 14 (1.3%) experienced renal failure. The national rate for AKI after isolated CABG was 1.9% in 2023. Chronic lung disease was a risk factor for AKI development. The mean perfusion, cross-clamp, ventilator times, and hospital stay increased in AKI patients. All patients who suffered from AKI had undergone perioperative blood transfusion. Our single-center experience with renal failure is slightly better than the national average. In our population, chronic lung disease and lower preoperative ejection fractions were associated with increased rates of AKI. Modifiable risk factors in our population included perioperative blood transfusion and increased perfusion/cross-clamp times. Lastly, AKI patients spent longer time on ventilators, increased lengths of stay, and increased postoperative mortality.

摘要

急性肾损伤(AKI)是心脏手术常见术后并发症中最严重的并发症之一,可增加患者的短期和长期发病率及死亡率。本研究旨在探讨导致AKI的可能危险因素。我们试图将我们的AKI发生率与胸外科医师协会(STS)报告的冠状动脉旁路移植术(CABG)的全国平均水平进行比较。我们回顾了我们机构在2020年1月1日至2023年6月30日期间进行的CABG手术中肾衰竭的数据。从数据库中,我们确定了1068例CABG患者,并回顾了人口统计学、不可改变的状况和可改变的危险因素。STS数据库使用风险、损伤、衰竭、失功和终末期肾病的定义来界定肾衰竭。在我们的患者样本中,14例(1.3%)发生了肾衰竭。2023年单纯CABG术后AKI的全国发生率为1.9%。慢性肺病是AKI发生的一个危险因素。AKI患者的平均灌注时间、主动脉阻断时间、呼吸机使用时间和住院时间均增加。所有发生AKI的患者均接受了围手术期输血。我们单中心关于肾衰竭的经验略优于全国平均水平。在我们的人群中,慢性肺病和术前较低的射血分数与AKI发生率增加相关。我们人群中的可改变危险因素包括围手术期输血以及灌注/主动脉阻断时间增加。最后,AKI患者呼吸机使用时间更长、住院时间延长且术后死亡率增加。

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