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目的分析冠状动脉造影检查后行瓣膜置换术患者的肾功能变化,总结术前冠状动脉造影检查是否会增加术后急性肾损伤的发生率。方法收集2013年1月至2015年9月西南医科大学附属医院心胸外科收治638例行心脏瓣膜置换术患者的临床资料,其中118例术前行冠状动脉造影检查(冠状动脉造影检查组),520例未行冠状动脉造影(非冠状动脉造影检查组)。在患者手术前(T0),术后12 h(T1)、24 h(T2)、48 h(T3)4个时间点测量血清肌酐(Scr)、尿素氮(Bun)、脑钠肽(BNP)、血清磷酸肌酸激酶同功酶(CK-MB)、心肌肌钙蛋白I(cTnI)值,并记录术后48 h急性肾损伤发生的例数。结果尽管与非冠状动脉造影检查组比较,冠状动脉造影检查组的术后24 h和48 h Scr值增加[(91.6±37.7)μmol/L vs(.81.0±27.4)μmol/L,(84.9±23.6)μmol/L vs(.73.5±25.3)μmol/L],且差异有统计学意义;但两者急性肾损伤的发生率和心肌酶各项指标差异均无统计学意义。结论术前冠状动脉造影检查并不会增加患者术后急性肾损伤的发生率。
Objective To analyze the changes of renal function in patients undergoing valvular replacement after coronary angiography, and to summarize whether preoperative coronary angiography can increase the incidence of postoperative acute kidney injury. Methods A total of 638 patients undergoing heart valve replacement were enrolled in the Department of Cardiothoracic Surgery, the Affiliated Hospital of Southwest Medical University from January 2013 to September 2015. Among them, 118 patients underwent coronary angiography (coronary angiography), 520 Cases of coronary angiography (non-coronary angiography group). Serum creatinine (Scr), blood urea nitrogen (Bun) and brain natriuretic peptide (BNP) were measured at 4 time points before operation (T0), 12 h (T1), 24 h (T2) and 48 h (CK-MB) and cardiac troponin I (cTnI), and the number of cases of acute renal injury 48 h after operation were recorded. Results Compared with non-coronary angiography group, the values of Scr in coronary angiography group at 24 h and 48 h after operation were significantly higher than those in non-coronary angiography group [(91.6 ± 37.7) μmol / L vs (81.0 ± 27.4) μmol / L, (84.9 ± 23.6) μmol / L vs (.73.5 ± 25.3) μmol / L, respectively). There was no significant difference between the two groups in the incidence of acute renal injury and myocardial enzymes. Conclusion Preoperative coronary angiography does not increase the incidence of postoperative acute kidney injury.