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| 非心肺转流冠状动脉旁路移植术中中心静脉压与术后急性肾损伤的相关性 |
| Correlation between intraoperative central venous pressure and acute kidney injury in patients undergoing off-pump coronary artery bypass surgery |
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| DOI：10.12089/jca.2024.10.007 |
| 中文关键词: 非心肺转流冠状动脉旁路移植术 急性肾损伤 中心静脉压 预后 |
| 英文关键词: Off-pump coronary artery bypass grafting Acute kidney injury Central venous pressure Prognosis |
| 基金项目:辽宁省重点研发计划项目（2019JH8/1030083） |
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| 中文摘要: |
目的：分析非心肺转流冠状动脉旁路移植术（OPCABG）患者术中中心静脉压（CVP）与术后急性肾损伤（AKI）的相关性。
方法：回顾性分析2018—2021年解放军北部战区总医院和2019—2022年大连医科大学附属第二医院所有行OPCABG的临床资料。通过电子病历系统和手麻系统收集术前一般情况、术中情况。根据术后7 d内是否发生AKI将患者分为两组：AKI组和非AKI组。绘制术中平均CVP与术后AKI的受试者工作特征（ROC）曲线，确定术中平均CVP的最佳截断值。采用多因素Logistic回归分析术中平均CVP与术后AKI之间的相关性。
结果：共有400例（34.9%）患者发生AKI。与非AKI组比较，AKI组年龄明显增大（P<0.05），BMI、血清肌酐浓度、术前合并高血压和糖尿病的注射胰岛素治疗比例、平均CVP、急性低血压发作比例明显升高（P<0.05），术中尿量明显减少（P<0.05），低血压时间明显延长（P<0.05）。在完全调整人口统计学、术前合并症以及术中指标集用药等协变量后，术中平均CVP每升高1 mmHg，发生AKI的几率增加1.47倍（OR=1.47，95%CI 1.36～1.59，P<0.001）。术中平均CVP与术后AKI的ROC曲线确定术中平均CVP的最佳截断值为10.11 mmHg，多因素回归模型显示，术中平均CVP≥10.11 mmHg的患者术后发生AKI的概率是术中平均CVP<10.11 mmHg患者的4.14倍。
结论：OPCABG术中平均CVP升高（≥10.11 mmHg）与术后AKI的较高风险独立相关。 |
| 英文摘要: |
Objective: To investigate the relationship between intraoperative central venous pressure (CVP) and postoperative acute kidney injury (AKI) in off-pump coronary artery bypass grafting (OPCABG).
Methods: A retrospective analysis was conducted, collecting clinical data from patients who underwent OPCABG at the General Hospital of Northern Theater Command of the Chinese People's Liberation Army between 2018 and 2021, and at the Second Affiliated Hospital of Dalian Nedical University between 2019 and 2022. Preoperative, intraoperative, and postoperative data were gathered using electronic medical record and anesthesia systems. The patients were divided into two groups according to whether AKI occurred within 7 days after surgery: AKI group and non-AKI group. The receiver operating characteristic (ROC) curve of intraoperative average CVP and postoperative AKI was plotted to determine the optimal cutoff value of intraoperative average CVP. Multivariate logistic regression analysis was used to assess the correlation between intraoperative average CVP and postoperative AKI.
Results: AKI occurred in 400 patients (34.9%). Compared with the non-AKI group, the age was older (P < 0.05), the BMI and serum creatinine levels, the proportion of insulin therapy among patients with preoperative hypertension and diabetes, the average CVP, and the incidence of acute hypotensive episodeswas higher (P < 0.05), the intraoperative urine output was significantly reduced (P < 0.05), and the duration of hypotension was longer (P < 0.05) in the AKI group. After fully adjusting for demographics, preoperative comorbidities, and intraoperative variables such as medication use and other covariates, each 1 mmHg increase in intraoperative average CVP was associated with a 1.47-fold increase in the odds of developing AKI (OR = 1.47, 95% CI 1.36-1.59, P < 0.001). The ROC curve identified 10.11 mmHg as the optimal cutoff value for intraoperative average CVP. Patients with an intraoperative average CVP ≥ 10.11 mmHg had a 4.14-fold higher risk of developing postoperative AKI compared to those with CVP < 10.11 mmHg.
Conclusion: Elevated intraoperative average CVP (≥ 10.1 mmHg) is independently associated with a higher risk of postoperative AKI in OPCABG. |
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