Mangos G J, Brown M A, Chan W Y, Horton D, Trew P, Whitworth J A
Department of Renal Medicine, St George Hospital, Sydney, NSW, Australia.
Aust N Z J Med. 1995 Aug;25(4):284-9. doi: 10.1111/j.1445-5994.1995.tb01891.x.
Acute renal failure (ARF) is a recognised complication following cardiac surgery, but the incidence varies widely in the published literature and there are no Australian data available to help predict the risks of ARF in patients with pre-existing renal disease.
To determine the incidence, outcome and risk factors for ARF following cardiac surgery.
A retrospective case control analysis of 903 consecutive patients who had cardiac surgery (795 CABG, 68 valve/septal surgery, 40 combined valve/CABG) in 1992-93. ARF was defined as doubling of serum creatinine concentration (Cr) to > 0.13 mmol/L if serum Cr was < or = 0.13 mmol/L pre-operatively, or else a rise in serum Cr of > or = 0.10 mmol/L after cardiac surgery. For each subject with ARF, two case control subjects were matched for date of surgery, surgeon, age, sex, type of surgery and pre-operative serum Cr to permit analysis of the influence of pre-operative factors (hypertension, diabetes mellitus, left ventricular systolic dysfunction) and for the comparison of cardiopulmonary bypass time upon the development of ARF. Subsidiary endpoints were mortality, need for dialysis and length of hospital stay.
ARF developed in only 1.1% of patients with 'normal' pre-operative renal function (creatinine < or = 0.13 mmol/L) and none required dialysis. ARF developed in 16% of those with impaired pre-operative renal function, 20% of whom required dialysis. Mortality from ARF was 13%. The risk of ARF rose from 10.4% in those with pre-operative serum Cr 0.14-0.20 mmol/L to 36.8% if the serum Cr was > 0.20 mmol/L (p < 0.01). Mortality was higher (4.2% vs 0.7%, p < 0.01) and length of hospital stay longer (14.5 vs nine days [median], p < 0.001) in those with impaired pre-operative renal function. ARF was more likely in those over 65 years, if valve surgery was included and where there was prolonged cardiopulmonary bypass time.
These data confirm that ARF following cardiac surgery is uncommon without pre-operative impairment of renal function but currently carries a mortality rate of 13%. Impaired renal function alone is associated with higher mortality and prolonged hospital stay. Studies to prevent ARF in this setting should focus on the high risk subsets described in this study.
急性肾衰竭（ARF）是心脏手术后公认的并发症，但已发表文献中的发病率差异很大，且尚无澳大利亚的数据可用于预测已有肾脏疾病患者发生ARF的风险。
确定心脏手术后ARF的发病率、转归及危险因素。
对1992 - 1993年间连续903例行心脏手术的患者（795例行冠状动脉搭桥术[CABG]，68例行瓣膜/间隔手术，40例行瓣膜/CABG联合手术）进行回顾性病例对照分析。ARF的定义为：术前血清肌酐浓度（Cr）<或=0.13 mmol/L时，血清Cr浓度翻倍至>0.13 mmol/L；或心脏手术后血清Cr升高>或=0.10 mmol/L。对于每例发生ARF的患者，匹配两名病例对照对象，使其手术日期、手术医生、年龄、性别、手术类型及术前血清Cr相同，以分析术前因素（高血压、糖尿病、左心室收缩功能障碍）的影响，并比较体外循环时间对ARF发生的影响。次要终点为死亡率、透析需求及住院时间。
术前肾功能“正常”（肌酐<或=0.13 mmol/L）的患者中，仅1.1%发生ARF，且无人需要透析。术前肾功能受损的患者中，16%发生ARF，其中20%需要透析。ARF导致的死亡率为13%。术前血清Cr为0.14 - 0.20 mmol/L的患者发生ARF的风险为10.4%，若血清Cr>0.20 mmol/L，风险则升至36.8%（p<0.01）。术前肾功能受损的患者死亡率更高（4.2%对0.7%，p<0.01），住院时间更长（中位数分别为14.5天和9天，p<0.001）。65岁以上患者、接受瓣膜手术患者及体外循环时间延长的患者更易发生ARF。
这些数据证实，心脏手术后若无术前肾功能损害，ARF并不常见，但目前死亡率为13%。单纯肾功能受损与更高的死亡率及更长的住院时间相关。在此情况下预防ARF的研究应聚焦于本研究中描述的高危亚组。
