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目的:应用倾向性评分匹配方法探讨体外循环及非体外循环两种冠状动脉旁路移植术式对术后急性肾损伤(acute kidney injury,AKI)的影响。方法:收集2008年1月—2012年12月在南京医科大学附属南京医院心脏外科进行体外循环下及非体外循环下行冠状动脉旁路移植术患者资料,应用倾向性评分匹配方法分析两组患者术后AKI的发生率及其影响因素。采用多因素Logistic回归分析影响术后AKI发生的危险因素。结果:共有770例冠状动脉旁路移植术患者符合纳入标准,根据手术方式分为体外循环组568例,非体外循环组202例。在倾向性评分匹配之前,体外循环组与非体外循环组各变量间(如射血分数、机械通气时间)差异均存在统计学意义。通过使用倾向性评分匹配方法,202例体外循环组和202例非体外循环组配对成功,体外循环组和非体外循环组各变量差异无统计学意义。倾向性评分匹配后的队列分析显示,体外循环组发生AKI 72例(占35.64%),非体外循环组发生AKI 46例(占22.77%),两组差异有统计学意义(χ~2=8.092,P=0.004);非体外循环组住院时间较体外循环组短,差异有统计学意义(χ~2=2.757,P<0.05);体外循环和非体外循环组病死率差异无统计学意义(χ~2=0,P=1.000);两组患者肾脏替代的发生率差异无统计学意义。结论:非体外循环手术方式可降低术后AKI的发生率。
Objective: To explore the effect of two types of coronary artery bypass grafting on cardiopulmonary (AKI) after cardiopulmonary bypass and non-cardiopulmonary bypass with propensity score matching. Methods: The data of patients undergoing coronary artery bypass grafting under cardiopulmonary bypass and non-cardiopulmonary bypass with coronary artery bypass grafting from Nanjing Hospital of Nanjing Medical University from January 2008 to December 2012 were collected. Tendency score matching method was used to analyze the data of two groups of patients The incidence of post-AKI and its influential factors. Multivariate logistic regression analysis was used to analyze the risk factors of postoperative AKI. Results: A total of 770 patients undergoing coronary artery bypass grafting met the inclusion criteria and were divided into 568 cases of cardiopulmonary bypass and 202 cases of cardiopulmonary bypass. Prior to the propensity score matching, there was a statistically significant difference between the variables of CPB group and non-CPB group (such as ejection fraction and mechanical ventilation time). Through the use of propensity score matching method, 202 cases of cardiopulmonary bypass group and 202 cases of non-cardiopulmonary bypass group paired successfully, there was no significant difference between the variables of cardiopulmonary bypass group and non-cardiopulmonary bypass group. Cohort analysis of propensity scores matched showed that there were 72 cases of AKI in cardiopulmonary bypass group (35.64%) and 46 cases of AKI in non-cardiopulmonary bypass group (22.77%), the difference was statistically significant (χ ~ 2 = 8.092 , P = 0.004). The hospitalization time of off-pump group was shorter than that of CPR group (χ ~ 2 = 2.757, P <0.05). There was no significant difference in the mortality rate between cardiopulmonary bypass and non-cardiopulmonary bypass group χ ~ 2 = 0, P = 1.000). There was no significant difference in the incidence of renal replacement between the two groups. Conclusion: Off-pump surgery can reduce the incidence of postoperative AKI.