摘要目的 对接受非体外循环下冠状动脉搭桥术(OPCAG)65岁以上患者依据术后第1天肌酐清除率分组,回顾性分析其危险因素和预后的关系.方法 2007年7月至2008年12月接受OPcAG 462例65岁以上患者,据术后第1天肌酐清除率分为肾功能正常(Ⅰ组)、轻度损伤(Ⅱ组)和中重度损伤(Ⅲ组)3组,比较手术并发症、气管插管时间、监护室留观时间、病死率等指标.结果 3组患者在术前合并症、射血分数、左室舒张末径、血脂水平等均无明显区别;围术期肌酐清除率(ml/min)与术前比有所下降[Ⅰ组:(37.9±1.0)比(58.0±5.1);Ⅱ组:(70.0±3.6)比(80.1±3.6);Ⅲ组:(109.9±14.9)比(100.0±13.6)、B型脑钠肽(BNP)增高(Ⅰ组:223.7±33 8.2、Ⅱ组:113.2±144.5、Ⅲ组:97.8±115.0)、肌酸肌酶同工酶及总胆红索浓度升高、左室舒张末径增大与术后并发症密切相关(P＜0.01).结论 围术期肾功能中重度损伤(肌酐清除率＜50 ml/min)合并总胆红素浓度、BNP水平、左室舒末径异常是影响非体外循环下冠脉搭桥术高龄患者预后的危险因素.OPCAG对患者的肾功能有一定的损伤作用,术前肌酐清除率异常者(＜80 ml/min)应采取措施积极预防发生严重的肾损伤或其他并发症.

abstractsObjective To analyze the risk factors in the patients over 65 years old undergoing offpump coronary artery bypass grafting (OPCAG) as grouped by postoperative creatinine clearance rate (Ccr).Methods A total of 462 consecutive patients over 65 years old undergoing OPCAG from January 2007 to December 2008 were recruited. They were divided into 3 groups by renal functions: normal, minor injury and moderate-severe injury. The risk factors were analyzed by a comparison of postoperative complications,duration of intubation, stay of intensive care unit and mortality rate, et al. Results There was no significant difference between the parameters of preoperative complications, left ventricle ejection fraction (LVEF), left ventricle end diastolic diameter (LNEDD) and lipid level, et al. And the postoperative complications were closely related to the decrease of Ccr and the increases of B-type natriuretic peptide ( BNP), CKMB, total bilirubin (TBIL) and LVEDD ( P ＜0. 01 for each). Conclusions The moderate-severe renal injury ( Ccr ＜ 50ml/min) with the abnormal levels of TBIL, BNP and LVEDD are the risk factors for a worse prognosis in OPCAG patients over 65 years old. Because of the injury of OPCAG, we should pay attention to patients with abnormal renal function (Ccr ＜80 ml/min) to prevent an onset of severe complications.