本文選題：體外循環(huán)　切入點：冠狀動脈搭橋　出處：《首都醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的分析體外循環(huán)不停跳冠脈搭橋術(shù)后急性腎損傷的危險因素及風(fēng)險評估。方法對2015年1月1日至2016年12月31日期間,于北京安貞醫(yī)院心臟外科收治的90例不穩(wěn)定性心絞痛的患者,接受體外循環(huán)輔助下心臟不停跳冠狀動脈旁路移植手術(shù)的病人進行回顧性研究。排除標(biāo)準(zhǔn):(1)年齡18周歲;(2)術(shù)前已行腎臟替代治療;(3)病案數(shù)據(jù)缺失;(4)患者術(shù)中死亡。根據(jù)全球急性腎損傷臨床轉(zhuǎn)歸協(xié)作機構(gòu)(Kidney Disease:Improving Global Outcomes,KDIGO)提出的急性腎損傷(acute kidney injury,AKI)診斷標(biāo)準(zhǔn),全部患者被分為AKI組(n=29)與非AKI組(n=61)兩組進行資料分析。將患者于我院住院期間所采集的臨床數(shù)據(jù)錄入數(shù)據(jù)庫,運用T檢驗,U檢驗,χ2檢驗,Logistic回歸分析等確定術(shù)后AKI的獨立危險因素。根據(jù)相關(guān)危險因素指標(biāo)優(yōu)勢比(odds ratio,OR)值構(gòu)建風(fēng)險預(yù)測評估系統(tǒng),并驗證擬合度。結(jié)果術(shù)后發(fā)生AKI患者29例(29/90,32.2%),單因素組間分析年齡,高血壓病史,射血分數(shù),估測腎小球濾過率水平,術(shù)中低血壓時間60min,體外循環(huán)運轉(zhuǎn)時間120min,橋血管數(shù)量,出血量,術(shù)后低血壓時間60min,機械輔助呼吸時間40h,應(yīng)用IABP輔助是此類手術(shù)發(fā)生術(shù)后AKI的危險因素。Logistic回歸分析術(shù)前左心室射血分數(shù)EF(%)、術(shù)中CPB時間120min、術(shù)中低血壓時間60min是術(shù)后發(fā)生AKI的獨立危險因素。將變量分組后再行l(wèi)ogistic多因素回歸分析,得到評分系統(tǒng)如下:年齡≥65歲2分;EF45%為3分、45%≤EF50%為2分、50%≤EF55%為1分;體外循環(huán)時間120min為2分;低血壓時間60min為1分;機械輔助呼吸40h為3分;IABP輔助為1分;估測腎小球濾過率100 mL/min/1.73m2以下每下降20增加1分。評分總計15分。結(jié)論左心室射血分數(shù)低下、體外循環(huán)時間120min、術(shù)中低血壓時間60min是體外循環(huán)輔助不停跳冠脈搭橋術(shù)后急性腎損傷的獨立危險因素。通過分析我們得到了針對體外循環(huán)輔助下不停跳冠脈搭橋術(shù)后發(fā)生AKI的總分15分的評分系統(tǒng),超過7分提示術(shù)后并發(fā)AKI風(fēng)險較高,具有一定判別能力,但需更大樣本量的矯正。
[Abstract]:Objective to analyze the risk factors and risk assessment of acute renal injury after beating coronary artery bypass grafting under cardiopulmonary bypass (CPB).Methods from January 1, 2015 to December 31, 2016, 90 patients with unstable angina pectoris were treated in cardiac surgery, Anzhen Hospital, Beijing.A retrospective study was conducted in patients undergoing cardiopulmonary bypass (CPB)-assisted coronary artery bypass grafting (CABG).Exclusion criteria: 1) 18 years old / 2) preoperative renal replacement therapy / 3) absence of medical record data / 4) Intraoperative death.According to the diagnostic criteria proposed by Kidney Disease:Improving Global Outcomers KDIGO, all the patients were divided into two groups: AKI group (n = 29) and non-#en4# group (n = 61).The clinical data collected in our hospital were entered into the database, and the independent risk factors of postoperative AKI were determined by T test U test, 蠂 2 test and Logistic regression analysis.The risk prediction and evaluation system was constructed according to the odds odds odds ratio of the relative risk factors, and the fitting degree was verified.Results 29 cases of AKI occurred after operation. Age, history of hypertension, ejection fraction, glomerular filtration rate, hypotension time, cardiopulmonary bypass (CPB) time, graft blood vessel count and bleeding volume were analyzed in 29 patients with AKI.Postoperative hypotension time was 60 min, mechanically assisted respiration time was 40 h. IABP was used as a risk factor for postoperative AKI. Logistic regression analysis showed that left ventricular ejection fraction (LVEF) was used before operation, CPB time was 120 min and intraoperative hypotension time (60min) was postoperative.Independent risk factors for AKI.The logistic multivariate regression analysis was performed after the variables were grouped, and the scoring system was obtained as follows: age 鈮，

本文編號：1724976