摘要目的 探讨术前血清尿酸水平对非体外循环冠状动脉旁路移植术后发生急性肾损伤的影响,明确血清尿酸是否为术后急性肾损伤发生的预测因素.方法 分析2018年1月至6月631例非体外循环冠状动脉旁路移植术患者临床资料.根据入选患者术前1天SUA水平计算出SUA中位数(384μmol/L),将患者分为高尿酸组(SUA高于384μmol/L)和低尿酸组(SUA低于384μmol/L),比较两组患者性别、年龄、合并症及查尔森合并症指数(CCI)评分,术前用药情况、血肌酐及肾小球滤过率,术中手术时间、输液量及冰冻血浆使用量,术后急性肾损伤分期情况、连续性肾替代治疗及再次手术率等.结果 631例患者中有83例(13.2％,83/631)术后发生急性肾损伤,其中65例(78.3％,65/83)术前血清尿酸水平高于中位数(OR=3.143,95％CI:1.850～8.798,P=0.001).校正后行多因素变量分析显示,血清尿酸水平高于中位数,体质量指数>30 kg/m2、术前血清肌酐水平升高、肾小球滤过率<60 ml/min及CCI评分与急性肾损伤独立相关.术中输液量、糖尿病和术前利尿药物使用与心脏术后急性肾损伤的发生无相关性.结论 血清尿酸水平升高是非体外循环冠状动脉旁路移植术后急性肾损伤发生的独立预测因素.

abstractsObjective To investigate the effect of preoperative serum uric acid level on the incidence of acute kidney in-jury after off-pump coronary artery bypass grafting and to discuss whether serum uric acid level is an independent predictor of postoperative acute kidney injury.Methods A total of 631 patients undergoing off-pump coronary artery bypass grafting in Anzhen Hospital from January 2018 to June 2018 were reviewed.Patients were divided into high uric acid group(higher-than-median)and low uric acid group(lower-than-median) , based on the preoperative serum uric acid level of the patients.The de-mographic variables, comorbidities, the chelsea comorbidity index, preoperative medication, serum creatinine level and glo-merular filtration rate were compared between the two groups.Meanwhile, intraoperative operative time, infusion volume, post-operative acute kidney injury staging and the rate of frozen plasma usage , continuous renal replacement therapy and reoperation rate were observed.Results Among the 631 patients, 83(13.2％, 83/631)cases developed postoperative acute kidney inju-ry, 65(78.3％, 65/83) cases had a higher level of preoperative serum uric acid above the median(OR =3.143, 95％CI:1.850-8.798, P=0.001).After adjustment, multivariate analysis showed that elevated level of serum uric acid and BMI >30 kg/m2, the increase of preoperative serum creatinine level, the decrease of glomerular filtration rate( <60 ml/min) and higher CCI score were associated with postoperative acute kidney injury independently .Intraoperative fluid volume , diabetes and preoperative diuretic administration did not relate to the incidence of acute kidney injury after cardiac surgery .Conclusion Elevated serum uric acid level can be a strong predictor for the incidence of acute kidney injury after off-pump coronary artery bypass grafting.