【摘要】：目的探討重度腎功能損害患者行非體外循環(huán)冠狀動脈旁路移植術(shù)(off-pump coronary artery bypass grafting,OPCABG)術(shù)后應(yīng)用持續(xù)腎臟替代治療(continuous renal replacement therapy,CRRT)的術(shù)前獨(dú)立危險因素。方法訪問首都醫(yī)科大學(xué)附屬北京安貞醫(yī)院麻醉科OPCABG圍術(shù)期數(shù)據(jù)庫,收集2012年2月至2016年7月術(shù)前血清肌酐(Cr)重度升高(血清Cr值≥正常值1.5倍)患者行OPCABG的臨床資料,統(tǒng)計術(shù)后CRRT發(fā)生情況,采用Logistic回歸分析CRRT的術(shù)前獨(dú)立危險因素。結(jié)果共納入45例患者,術(shù)后應(yīng)用CRRT有9例(20%)。與非CRRT患者比較,CRRT患者術(shù)前血清Cr和尿素氮(BUN)濃度明顯升高,術(shù)中尿量明顯減少,術(shù)后12、24h血清Cr濃度明顯升高,術(shù)后ICU時間明顯延長,院內(nèi)死亡率明顯升高(P0.05或P0.01)。Logistic回歸分析顯示,術(shù)前血清Cr濃度升高為術(shù)后CRRT的獨(dú)立危險因素(OR=1.05,95%CI 1.05~1.10,P=0.046)。當(dāng)術(shù)后12h血清Cr濃度166μmol/L時,每升高1μmol/L,術(shù)后CRRT治療率增加5%(OR=1.05,95%CI 1.01~1.08,P=0.013),但在血清Cr濃度350μmol/L時,達(dá)到封頂效應(yīng)。結(jié)論術(shù)前血清Cr重度升高患者OPCABG術(shù)后CRRT治療率為20%,而術(shù)前血清Cr濃度升高是OPCABG患者術(shù)后CRRT的獨(dú)立危險因素。
[Abstract]:Objective to investigate the preoperative independent risk factors of continuous renal replacement therapy (continuous renal replacement therapy,CRRT) after off-pump coronary artery bypass grafting (off-pump coronary artery bypass grafting,OPCABG) in patients with severe renal dysfunction. Methods the perioperative OPCABG database of Anzhen Hospital affiliated to Capital Medical University was used to collect the clinical data of patients with severe elevation of serum creatinine (Cr) (serum Cr 鈮，

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