摘要目的 探讨体外循环下冠状动脉旁路移植术后发生急性肾损伤( AKI)的影响因素.方法 选择2016年3月至2018年11月在梅州市人民医院行体外循环下冠状动脉旁路移植术的患者55例,回顾性分析其临床资料,根据术后是否出现AKI进行分组,分析患者的临床资料、实验室指标、术后临床指标,同时对各影响因素进行Logistic多因素回归分析.结果 55例患者中,发生AKI 20例(AIK组),未发生AKI 35例(非AKI组),AKI的发生率为36.36%. AKI组年龄、体质量、主动脉阻断时间、体外循环(CPB)时间、术前肌酐(Cr)、术后Cr、机械通气时间与非AKI组比较,差异均有统计学意义(P均＜0.05);Logistic多因素回归分析结果提示,年龄≥65岁、术前、术后Cr水平,主动脉阻断时间及机械通气时间是体外循环下冠状动脉旁路移植术后发生AKI的独立危险因素(P＜0.05).结论 高龄、术前和术后Cr水平、主动脉阻断时间等多种围术期因素与AKI发生有关,临床应强化围术期对患者的监测,尽早干预,预防AKI发生.

abstractsObjective To probe into the influencing factors of acute kidney injury (AKI) after coronary artery bypass grafting under cardiopulmonary bypass .Methods A total of 55 patients who underwent coronary artery bypass grafting under cardiopulmonary bypass in Meizhou People’s Hospital from March 2016 to November 2018 were selected .And their clinical data were analyzed retrospectively . Patients in the study were grouped according to occurrence of AKI .Then, the clinical data , laboratory indicators and postoperative clinical indexes were analyzed , and Logistic multivariate regression analysis were performed to analyze influencing factors .Results Twenty cases of 55 patients had AKI (AIK group), 35 cases did not develop AKI (non-AKI group), and the incidence of AKI was 36.36%.The age, body weight, aorta blocking time, cardiopulmonary bypass ( CPB) time, preoperative chromium , postoperative chromium, mechanical ventilation time were compared between AKI group and non -AKI group, and the difference was significant (P＜0.05).Logistic multivariate regression analysis showed that age (≥65 years old), preoperative and postoperative creatinine level , aorta pulse blocking time and mechanical ventilation time were independent risk factors of AKI after coronary artery bypass grafting under cardiopulmonary bypass (P＜0.05).Conclusions The age, preoperative and postoperative chromium level ,aorta blocking time and other perioperative factors are related to the occurrence of AKI , so the perioperative surveillance of patients should be strengthened and early intervention should be taken to prevent AKI .