文章摘要
刘 博,王其逊,粟家元,王晓伟.2型糖尿病对于非体外循环冠状动脉旁路移植术患者术后急性肾损伤等并发症的影响[J].南京医科大学学报,2018,(8):1089~1094
2型糖尿病对于非体外循环冠状动脉旁路移植术患者术后急性肾损伤等并发症的影响
Effects of type 2 diabetes on postoperative acute renal injury and other complications of off⁃pump coronery artery bypass grafting
投稿时间:2018-01-03  
DOI:10.7655/NYDXBNS20180815
中文关键词: 冠心病  冠状动脉旁路移植术  2型糖尿病  术后并发症  急性肾损伤
英文关键词: coronary heart disease  coronary artery bypass graft  type 2 diabetes  postoperative complication  acute kidney injury
基金项目:国家自然科学基金面上项目(81573234)
作者单位
刘 博 南京医科大学第一附属医院心胸外科江苏 南京 210029 
王其逊 南京医科大学第一附属医院心胸外科江苏 南京 210029 
粟家元 南京医科大学第一附属医院心胸外科江苏 南京 210029 
王晓伟 南京医科大学第一附属医院心胸外科江苏 南京 210029 
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中文摘要:
      目的:研究调查2型糖尿病(diabetes mellitus,DM)对于非体外循环冠状动脉旁路移植术患者术后急性肾损伤(acute kidney injury,AKI)等并发症的影响。方法:回顾性分析2012年1月—2017年9月本院894例行非体外循环冠状动脉旁路移植术(off?pump coronery artery bypass grafting,OP?CABG)患者的临床资料,其中合并DM患者318例、非DM患者576例;通过Graphpad prism分析组间关系确立有无统计学差异。结果:两组相比,术后血清肌酐(serum creatinine,Scr)、肾小球滤过率(estimated glomerular filtration rate,eGRF)、肌酸酐清除率(creatinine clearance,CCr)有明显统计学差异,其中在48 h可计算得t值最高(t=3.36),P值达最小,其中Scr在12 h时组内均值最高,且离均差出现明显增大,多数患者于48 h时回落至术前水平。部分患者甚至出现冠脉搭桥术术后CCr、Scr及eGRF小于术前值,此时各组组内变异达最大。结论:合并DM的OP?CABG患者较不合并DM的患者术后易发AKI,其多于术后12 h出现高峰,并于此时出现明显的组内及组间差异,个体肾功能呈加重或转归趋势。两组患者术后AKI进程与全身炎症反应的进程不平行,前者多于48 h转复至正常,后者则呈继续上升趋势。
英文摘要:
      Objective:To investigate the effects of type 2 diabetes on postoperative acute renal injury (AKI) and other complications of off?pump coronery artery bypass grafting(OP?CABG). Methods:Retrospectively analysed 894 cases of patients with OP?CABG from January 2012 to September 2017 in our hospital,including 318 patients with diabetes mellitus(DM)and 576 patients without DM. The statistical differences was analyzed using Graphpad Prism. Results:In total 894 patients of this study,there were significant differences in serum creatinine(SCr),glomerular filtration rate(eGFR),and creatinine clearance(CCr)after surgery between two groups. At 48h,SCr has the highest T?value(t=3.36)and P < 0.01. The intra?group mean of SCr was the highest at 12 h,and the deviation showed a significant increase,while the majority of patients fell back to preoperative level at 48h. Even in some patients,CCr,SCr and eGRF were smaller than preoperative values after coronary artery bypass surgery. Conclusion:Compared to patients without DM,patients with DM were more prone to AKI after OP?CABG,which appeared most at 12 h after surgery and had significant inter?group and intra?group difference in this time. Individual kidney showed a trend of deterioration or heal. In the two groups,the process of the AKI was not parallel to the process of systemic inflammatory response. The former healed at 48 h,while the latter continued to be aggravated.
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