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目的:探讨急性肾损伤(acute kidney injury,AKI)在非体外冠状动脉旁路移植(off pump coronary artery bypass,OPCAB)术后发生的影响因素及对患者预后的影响。方法:选择连续行择期OPCAB的505例患者为研究对象,根据AKI的RIFLE诊断标准,以是否发生AKI把患者分为AKI组和非AKI组,对比分析两组间临床资料的差异。将差异有统计学意义的因素作为自变量进行Logistic退步法回归分析,寻找AKI的相关影响因素。结果:术后有9.9%(50/505)患者发生AKI,多因素回归分析显示术前NYHA分级Ⅲ~Ⅳ级(P<0.05,OR=2.659)、术前血肌酐水平(P<0.05,OR=3.043)、手术方式(P<0.05,OR=4.097)、围术期使用主动脉球囊反搏(IABP)(P<0.05,OR=7.185)、术后输血量≥10 U(P<0.05,OR=3.931)是术后AKI的危险因素。AKI患者术后机械通气时间、ICU停留时间延长,新发透析及术后30d死亡率增高。结论:术后AKI明显增加OPCAB患者住院并发症和死亡率,应尽可能采取预防措施降低风险以降低术后AKI的发生率。
Objective: To investigate the influencing factors of acute kidney injury (AKI) after off-pump coronary artery bypass (OPCAB) and its effect on the prognosis of patients. Methods: One hundred and fifty-five consecutive patients with OPCAB were enrolled in this study. Patients were divided into AKI group and non-AKI group according to the criteria of RIFLE for AKI. The differences of clinical data between the two groups were compared. Logistic regression regression analysis was used to find the relevant influencing factors of AKI with statistically significant factors as independent variables. Results: AKI occurred in 9.9% (50/505) patients after operation. Multivariate regression analysis showed that preoperative NYHA grade Ⅲ ~ Ⅳ (P <0.05, OR = 2.659), preoperative serum creatinine (P <0.05, OR (P <0.05, OR = 4.097). The aortic balloon counterpulsation (IABP) was used during the perioperative period (P <0.05, OR = 7.185) , OR = 3.931) is a risk factor for postoperative AKI. The duration of mechanical ventilation, the duration of ICU stay in AKI patients increased, and the mortality rate after new dialysis and postoperative 30d were higher. Conclusion: Postoperative AKI can significantly increase the hospitalized complications and mortality in patients with OPCAB. Preventive measures should be taken to reduce the risk and reduce the incidence of postoperative AKI.