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停跳与不停跳冠脉旁路移植术对肾功能影响的比较研究

发表者:王怀斌 571人已读

发表于《中华胸心血管外科杂志》

停跳与不停跳冠脉旁路移植术对肾功能影响的比较研究

[摘要] 目的:比较非体外循环冠脉旁路移植术(OPCAB)与体外循环下冠脉旁路移植术(CABG)对肾功能的影响。方法:30例冠脉旁路移植术病人,随机分为OPCAB组(O组,n=15)和CABG组(C组,n=15),连续测定围术期尿中肾小管释放酶N-乙酰基-β-D-葡萄糖苷酶(NAG)和γ-谷氨酰转移酶(γ-GT)浓度,同时测定血尿素氮(BUN)和肌酐(Cr)浓度,计算尿酶排量和Cr清除率。结果:两组病例均无肾衰发生,围术期尿量无显著差异(P>0.05)。围术期尿NAG和γ-GT排量术中均明显升高,术后第1日晨基本复原。其中,O组尿NAG峰值排量显著低于C组(P<0.05),而两组同时相尿γ-gt排量无显著差异(p>0.05)。两组病例血BUN和Cr术后均升高,组间差异无显著性(P>0.05)。围术期Cr清除率均先升高后下降,但C组波动明显大于O组,从术前(90.4±24.4)ml/min升至术中(139.4±46.2)ml/min(P<0.001),术后第1日降至(73.2±24.1)ml/min(P<0.001)。结论:OPCAB与CABG在肾小球和肾小管水平诱发可逆的亚临床肾损伤,相比较而言,前者对肾功能的影响小于后者。北京医院心血管外科王怀斌

[关键词] 冠脉旁路移植  非体外循环  肾脏损伤

A comparative study of the effects of OPCAB and CABG operations on renal function. Wang huaibin, et al. Department of Cardiothoracic, Beijing Hospital, Beijing 100730, China

[Abstract] Objective: To comparatively study the effects of off-pump (OPCAB) and on-pump (CABG) coronary artery bypass grafting operations on renal function. Methods: Thirty patients undergoing coronary surgery were randomly divided into group O (OPCAB, n=15) and group C (CABG, n=15). The changes in the parameter values of glomerular and tubular function were observed at various times during whole period. Results: There was no acute renal failure in either group, no significant difference in urine volume between the two groups (P>0.05). The levels of NAG/creatinine ratio and γ-GT/creatinine ratio were increased during operation, then returned to normal at first day postoperatively. The peak level of NAG/creatinine ratio in group C was much higher than that in group O (P<0.05). the="" levels="" of="" bun="" and="" creatinine="" were="" increased="" but="" no="" statistical="" differences="" between="" two="" groups="" found="" at="" same="" measure="" time="" p="">0.05). Creatinine clearance improved significantly in group C from a mean of(90.4±24.4)ml/min preoperatively to(139.4±46.2)ml/min during operation (P<0.001), then deteriorated to(73.2±24.1)ml/min postoperatively (P<0.001), which was significantly worse than the group O.Conclusion: Both OPCAB and CABG operations can yield some subclinically reversible renal injury at glomerular and tubular levels, comparatively the former has less effect on renal function than the latter.

[Key words] Coronary artery bypass grafting   Off-pump   Renal injury

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发表于:2017-12-28 17:03

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