Preoperative Statin Therapy Decreases Risk of Postoperative Renal Insufficiency

Introduction: Although current guidelines recommend withholding statins in perioperative patients, little information is available on whether perioperative statin use increases risk for postoperative renal failure. Aims: We examined the relation between preoperative statin therapy and postoperative risk for renal insufficiency in patients undergoing cardiac surgery. Methods: Retrospective cohort review from the Texas Heart Institute research database was performed. Patients were divided into two groups: those who received preoperative statins and those who did not. Primary outcome was the development of postoperative renal insufficiency (requiring dialysis or not). Outcomes were assessed in the entire cohort and in subgroups undergoing isolated coronary artery bypass grafting (CABG), isolated valve surgery, or combined CABG and valve surgery. Results: Of 3001 patients, 56% received preoperative statins. In multivariate logistic regression analysis, preoperative statins were associated with significant reductions in risk for postoperative renal insufficiency in the entire cohort (odds ratio [OR]= 0.60, 95% confidence interval [CI] 0.38–0.95) and in patients undergoing isolated CABG (OR = 0.34, 95% CI 0.17–0.68). In patients undergoing isolated valve surgery (OR = 1.35, 95% CI 0.61–2.96) or combined CABG and valve surgery (OR = 1.39, 95% CI 0.48–3.99), preoperative statins were not associated with decreased incidence of postoperative renal insufficiency. Age >65 years, preoperative renal insufficiency, history of congestive heart failure, preoperative intra‐aortic balloon pump insertion, and total cardiopulmonary bypass time >80 min were also independent predictors associated with increased risk for postoperative renal insufficiency. Conclusions: Preoperative statin therapy was associated with decreased incidence of postoperative renal insufficiency in patients undergoing cardiac surgeries, particularly in patients undergoing isolated CABG.     

体外循环心脏手术后急性肾损伤相关危险因素分析

目的 分析体外循环心脏手术后发生急性肾损伤(AKI)的危险因素及血肌酐(Scr)、尿素氮(BUN)的变化趋势.方法 回顾分析114例体外循环心脏直视手术患者的临床资料,根据基础Scr水平,采用AKI网络推荐标准(AKIN)分为A、B、C、D4个组,绘制四组Scr、Bun的变化趋势图,分析四组患者围手术期各项观察指标,探讨AKI发生的相关危险因素.结果 心脏术后发生AKI患者的Scr、Bun水平经历了1～3 d升高和2～3 d的恢复过程.单因素分析显示,术前Scr正常的患者,基础Scr值、体外循环(CPB)时间、阻断时间、术后总引流量、术后输入红细胞量是心脏术后发生AKI的相关危险因素.多因素回归分析显示,基础Scr值和LVEF＜40％可能是发生AKI的独立危险因素.对于肾功能不全者,术后总引流量是发生AKI的相关危险因素.结论 心脏术后肾功能指标Scr和BUN的变化趋势有一定规律.AKI的发生与多种围手术期危险因素密切相关,基础Scr值与肾功能可能并不一致.对心脏手术患者应加强术前评估和术中、术后监测,预防和减少AKI的发生.     

Off-pump coronary revascularization attenuates transient renal damage compared with on-pump coronary revascularization

STUDY OBJECTIVES: Cardiopulmonary bypass (CPB) represents a specific risk factor for renal damage during coronary revascularization. The purpose of this study was to compare the perioperative renal damage in patients undergoing on-pump and off-pump coronary surgery. DESIGN AND PATIENTS: The progress and extent of renal damage was prospectively studied in two groups of patients undergoing cardiac surgery without concomitant morbidity, undergoing elective coronary revascularization with (n = 12) and without (n = 10) CPB. Markers of glomerular function (creatinine clearance) and damage (microalbuminuria), and markers of tubular function (fractional excretion of sodium [FENa] and free water clearance) and damage (N-acetyl-beta-D glucosaminidase [NAG]) were evaluated. Measuring plasma concentrations of free hemoglobin assessed hemolysis. Plasma and urinary specimens were obtained at the following points: (1) baseline; (2) heparinization; (3) the end of CPB or completing graft for off-pump surgery; (4) skin closure; (5) the sixth hour in the ICU; and (6) the second postoperative day. Free water and creatinine clearances, FENa, and the urinary excretion of microalbumin and NAG were calculated for the corresponding time intervals. SETTING: University hospital. RESULTS: We found that off-pump coronary revascularization induced significantly less changes in microalbuminuria, FENa, free water clearance, NAG, and free hemoglobin as compared with operations with CPB. Markers returned to baseline within 2 days after the operation, and there was no clinical or laboratory evidence of overt renal dysfunction in both groups. CONCLUSION: Off-pump coronary surgery attenuates transient renal injury compared with traditional on-pump coronary artery bypass grafting.     

Effects of enalaprilat infusion on hemodynamics and renal function in patients undergoing cardiac surgery.

OBJECTIVE: This study was undertaken to evaluate the effect of enalaprilat infusion on hemodynamics and renal function during cardiopulmonary bypass (CPB). METHODS: Thirty adults undergoing CPB were randomly allocated into 2 groups. All patients received the same anesthetic protocol and same dopamine infusion protocol (2 mg/kg(-1)/min(-1)) during the study. In addition to dopamine infusion 15 patients received enalaprilat infusion (0.06 mg/kg(-1)/hr(-1)) during CPB. Blood creatinine, urea levels, and creatinine clearance (CLcr) were measured and cardiac output (CO) was calculated by echocardiography preoperatively and on the 6th postoperative day. Mean arterial pressure (MAP), central venous pressure (CVP), systemic vascular resistance (SVR) measurements were recorded during the operation and during postoperative 24 hours. RESULTS: In the control group postoperative blood creatinine and urea levels were significantly higher and CLcr measurements were significantly lower than the preoperative values (p<0.05). These values did not change in the enalaprilat group. Mean arterial pressure was similar in both groups (p>0.05), but SVR was lower (p<0.05) and CVP was higher (p<0.05) in the enalaprilat group than in the control group. In the enalaprilat group postoperative CO measurements were higher than the preoperative values (p<0.05). CONCLUSION: Our results demonstrate that enalaprilat infusion during CPB improves renal function and CO measurements in the early postoperative period.     

先天性心脏病相关肺动脉高压患儿术后急性肾损伤影响因素分析

目的 探讨先天性心脏病相关肺动脉高压（congenital heart disease associated with pulmonary arterial hypertension, CHD-PAH）患儿在体外循环术后早期发生急性肾损伤（acute kidney injury, AKI）的影响因素。 方法 2016年6月至2020年12月于我科在体外循环（cardiopulmonary bypass, CPB）下行心脏手术的3岁以下患儿,所有患儿均诊断为CHD-PAH,共纳入299例患儿,根据术后是否发生AKI分为AKI组（n=62）和非AKI组(n=237),收集围术期资料进行统计学分析。 结果 单因素Logistic回归分析结果显示包括年龄、身高、体质量、肺部感染、术前血清肌酐SCr值、术中CPB时间、主动脉阻闭时间（aortic occlusion time, ACT）、CHD 手术风险调整-1评分与术后AKI发生密切相关（P<0.05）,多因素Logistic回归分析结果显示年龄、术前肺部感染、术前SCr值、ACT是AKI发生的独立危险因素（P<0.05）;AKI组患儿术后并发症包括二次插管、肾脏替代治疗和血液感染明显高于 非AKI组（P<0.05）,术后机械通气时间、ICU停留时间、总住院时间明显延长和死亡率明显增高（P<0.05）。 结论 低年龄、术前低SCr值、术前存在肺部感染和长ACT是术后AKI发生的独立危险因素,对高危人群制定积极预防措施,可能是减少术后AKI发生,改善临床预后的有效途径。     

Coagulation activation and organ dysfunction following cardiac surgery

STUDY OBJECTIVES: Cardiac surgery with cardiopulmonary bypass (CPB) is associated with major inflammatory triggers that cause marked activation of the microcirculation. This inflammatory response is associated with significant organ dysfunction. How this response causes organ dysfunction is not well understood; consequently, few interventions exist to prevent or treat it. In other acute inflammatory conditions, such as sepsis, increased coagulation activation in the microcirculation may be a cause of organ injury. We documented the association between coagulation activation and organ dysfunction to investigate whether coagulation activation also plays a role in organ injury following cardiac surgery with CPB. DESIGN: Prospective study of 30 patients undergoing cardiac surgery with CPB. Prothrombin fragment (PTF) 1 + 2 and plasminogen activator inhibitor (PAI) activity were measured, and levels correlated with postoperative measures of organ function including the left-ventricular stroke work index, the Pao(2)/fraction of inspired oxygen (Fio(2)) ratio, and creatinine levels. RESULTS: PTF levels increased eightfold (p < 0.05), and PAI activity increased threefold (p < 0.05) over the first 4 h after CPB. PTF levels were correlated with deteriorations in the left-ventricular stroke work index (p = 0.04), the Pao(2)/Fio(2) ratio (p = 0.02), and creatinine levels (p = 0.02). CONCLUSIONS: Levels of coagulation activation are associated with markers of postoperative organ dysfunction. Additional studies are warranted to investigate whether strategies that limit coagulation activation are associated with reductions in postoperative organ dysfunction.     

Intra-aortic balloon pump use does not affect the renal function in patients undergoing off pump coronary artery bypass surgery

Renal dysfunction is known to occur during cardiac surgery. A few factors such as perioperative hypotension, use of potential nephrotoxic therapeutic agents, radio opaque contrast media in the recent past, intra-aortic balloon pump (IABP) and cardiopulmonary bypass have been blamed as the contributing factors to the causation of postoperative renal dysfunction in cardiac surgical patients. At times, in patients with renal failure and low cardiac output status, one may face the dilemma if the use of IABP is safe. We undertook this prospective observational study to determine the degree of possible renal injury when IABP is used by measuring serial values of serum creatinine and Cystatin C. Elective patients scheduled for off-pump coronary artery bypass surgery requiring preoperative use of IABP were included in this study. Cystatin C and serum creatinine levels were checked at fixed intervals after institution of IABP. Twenty-two patients were eligible for enrolment to the study. There was no significant change in the values of serum creatinine; from the basal value of 1.10 ± 0.233 to 0.98 ± 0.363 mg /dL (P value >0.05). Cystatin C levels significantly decreased from the basal level of 0.98 ± 0.29 to 0.89 ± 0.23 (P value <0.05). Contrary to the belief, Cystatin C, the early indicator of renal dysfunction decreases suggesting absence of renal injury after the use of IABP. Absence of elevation of cystatin C levels in our study suggests the lack of potential of the IABP to cause renal dysfunction in patients who received elective IABP therapy preoperatively.     

Incidence and predictors of ARDS after cardiac surgery

BACKGROUND: Severe pulmonary injury with the development of ARDS is a potential complication of cardiac surgery and cardiopulmonary bypass (CPB). STUDY OBJECTIVES: This retrospective, case-control study was designed to determine the incidence and mortality of ARDS after cardiac surgery and CPB, as well as to identify preoperative and perioperative predisposing factors of this complication. METHODS: Of 3,278 patients who underwent cardiac surgery and CPB between January 1995 and December 1998, 13 patients developed ARDS during the postoperative period. Each patient was matched with four or five control subjects who had the same type of surgery on the same day but did not develop postoperative respiratory complications. RESULTS: The incidence of ARDS was 0.4%, with an ARDS mortality of 15%. In the ARDS group, 38% had previous cardiac surgery, as compared to 3.5% in the control group (p < 0.002). During the postoperative period, ARDS patients received more blood products (4 +/- 5 vs 2 +/- 3; p < 0.01) and developed shock more frequently (31% vs 5%; p < 0.02) than patients in the control group. Multivariate regression analysis identified previous cardiac surgery, shock, and the number of transfused blood products as significant independent predictors for ARDS, with odds ratios of 31.5 (p = 0.015), 10.8 (p = 0.03), and 1.6 (p = 0.03), respectively. CONCLUSIONS: ARDS following cardiac surgery and CPB was a rare complication that carried a 15% mortality rate. Previous cardiac surgery, shock, and number of blood products received are important predicting factors for this complication.     

Effects of perioperative nesiritide in patients with left ventricular dysfunction undergoing cardiac surgery:the NAPA Trial.

OBJECTIVES: The purpose of this study was to determine the role nesiritide might play in patients with left ventricular dysfunction undergoing coronary artery bypass grafting (CABG) using cardiopulmonary bypass (CPB). BACKGROUND: Given the hemodynamic, neurohormonal, and renal effects of natriuretic peptides, nesiritide might be useful in the management of patients undergoing cardiac surgery. METHODS: This prospective, double-blind, exploratory evaluation randomly assigned patients with ejection fraction 相似文献   

Increased N-terminal pro-brain natriuretic peptide level predicts atrial fibrillation after surgery for esophageal carcinoma

AIM： To evaluate the value of plasma N-terminal pro- brain natriuretic peptide （NT-proBNP） level for predicting postoperative atrial fibrillation （AF） in patients undergoing surgery for esophageal carcinoma. METHODS： NT-proBNP levels were measured in 142 patients 24 h before and 1 h after surgery for esophageal carcinoma. All patients having a preoperative cardiac diagnosis by electrocardiogram （ECG）, remained under continuous monitoring for at least 48 h after surgery, and then underwent clinical cardiac evaluation until discharge. RESULTS： Postoperative AF occurred in 11 patients （7.7%）. AF patients were significantly older （69.6 ± 12.2 years vs 63.4 ± 13.3 years, P = 0.031） than non-AF patients. There were no significant differences in history of diabetes mellitus, sex distribution, surgical approach, anastomosis site, intraoperative hypotension and postoperative fever. The preoperative plasma NT-proBNP level was significantly higher in patients who developed postoperative AF （121.3 ± 18.3 pg/mL vs 396.1 ± 42.6 pg/mL, P = 0.016）. After adjustment for age, gender, chronic obstructive pulmonary disease （COPD）, history of cardiac diseases, hypertension, postoperative hypoxia and thoracic-gastric dilation, NT-proBNP levels were found to be associated with the highest risk factor for postoperative AF （odds ratio = 4.711, 95% CI = 1.212 to 7.644, P = 0.008）.CONCLUSION： An elevated perioperative plasma BNP level is a strong and independent predictor of postoperative AF in patients undergoing surgery for esophageal carcinoma. This finding has important implications for identifying patients at higher risk of postoperative AF who should be considered for preventive antiarrhythmic therapy.     

急性Stanford A型主动脉夹层患者术后肝功能不全的危险因素及预后分析

目的 探讨急性Stanford A型主动脉夹层患者术后发生肝功能不全(HD)的危险因素和预后.方法 回顾性分析青岛市市立医院2014年5月至2018年5月156例接受外科手术的急性Stanford A型主动脉夹层患者围术期资料.采用终末期肝病模型(MELD)评分评估患者术后肝功能,并分为HD组35例(MELD评分≥15...     

Does preoperative statin therapy improve outcomes in patients undergoing isolated cardiac valve surgery?

Preoperative statins have been associated with decreased mortality after coronary artery bypass grafting. Data are limited on whether these benefits extend to patients undergoing cardiac valve surgery. We examined whether preoperative statins decrease morbidity and mortality in patients undergoing isolated cardiac valve surgery. In a retrospective cohort analysis of consecutive patients who underwent surgical valve repair or replacement (excluding concomitant coronary artery bypass grafting, aortic root replacement, or ventricular assist device placement) at St. Luke's Episcopal Hospital, the primary outcome was 30-day mortality. Secondary outcomes included 30-day major adverse events (composite of early mortality, postoperative myocardial infarction, or stroke). Of 825 patients, 31% received preoperative statins (n = 255). Logistic regression analysis revealed that age >65 years (p = 0.02), history of congestive heart failure (p = 0.001), and total bypass time >80 minutes (p = 0.01) were independent predictors of increased 30-day mortality. Preoperative statin therapy was not associated with decreased 30-day mortality (odds ratio 0.89, 95% confidence interval 0.38 to 2.03), major adverse events (odds ratio 1.09, 95% confidence interval 0.61 to 1.96), postoperative myocardial infarction (p = 0.70), or stroke (p = 0.57). At a mean follow-up of 1.57 years, preoperative statin therapy was not associated with decreased mortality (p = 0.81). In the analysis using propensity score matching (354 propensity-matched patients, 177 in each group), preoperative statin was not associated with improved primary or secondary outcomes. In conclusion, preoperative statin therapy was not associated with a decrease in morbidity or mortality in patients undergoing isolated cardiac valve surgery.     

Effectiveness of preoperative breathing exercise interventions in patients undergoing cardiac surgery: A systematic review

Postoperative pulmonary complications are a common cause of morbidity and mortality in patients undergoing cardiac surgery, leading to an increase in length of hospital stay and healthcare costs.This systematic literature review aims to determine whether patients undergoing cardiac surgery who undergo preoperative breathing exercise training have better postoperative outcomes such as respiratory parameters, postoperative pulmonary complications, and length of hospital stay.Systematic searches were performed in the CINAHL, Cochrane Central Register of Controlled Trials, Cochrane Clinical Answers, Cochrane Database of Systematic Reviews, MEDLINE and MedicLatina databases. Studies were included if they examined adult patients scheduled for elective cardiac surgery, who underwent a preoperative breathing exercise training aimed at improving breathing parameters, preventing postoperative pulmonary complications, and reducing hospital length of stay. This systematic review was based on Cochrane and Prisma statement recommendations in the design, literature search, analysis, and reporting of the review.The search yielded 608 records. Eleven studies met the inclusion criteria. Ten studies were randomized controlled trials and one was an observational cohort study. Data from 1240 participants was retrieved from these studies and meta-analysis was performed whenever possible.A preoperative breathing intervention on patients undergoing cardiac surgery may help improve respiratory performance after surgery, reduce postoperative pulmonary complications and hospital length of stay. However, more trials are needed to support and strengthen the evidence.     

Preoperative renal dysfunction and clinical outcomes of cardiac surgery in octogenarians

Background

The proportion of elderly individuals is growing and the prevalence of chronic kidney disease (CKD) among elderly people undergoing cardiac surgery is increasing constantly. The aim of this study was to determine the influence of different degrees of preoperative renal dysfunction on postoperative outcomes in patients older than 80 years of age.

Methods

This is an observational study that included adult patients undergoing cardiac surgery in which data were collected prospectively. Patients were divided into groups according to their preoperative plasma creatinine and eGFR levels.

Results

From February 1997 to January 2010, 318 octogenarians underwent cardiac surgery. Of these, 140 patients (44%) had abnormal preoperative creatinine levels. A significantly higher incidence of postoperative sepsis (4% vs. 17%, p 0.03), CVA (1% vs. 6%, p 0.03), and prolonged hospital stay (16 ± 13 vs. 20 ± 16 days, p 0.04) were detected in patients with preoperative kidney dysfunction. Subgroup analysis revealed that preoperative CKD stage IV (eGFR 15–30 ml/min/1.73 m²) but not CKD stage III (eGFR 30–60 ml/min/1.73 m²) and preoperative creatinine > 1.8 mg/dl were independently associated with increased incidence of postoperative CVA (OR 4; 95% CI 0.07–0. 8, p = 0.05 for eGFR, and OR 7.8; 95% CI 1.2–60, p = 0.003 for creatinine). However, no significant increment in postoperative mortality with decreasing eGFR or increasing preoperative creatinine was demonstrated.

Conclusions

A substantial increase in the risk of postoperative CVA and sepsis, but not mortality, was demonstrated in octogenarians with advanced but not mild degrees of preoperative CKD. Compared to younger patients, a high burden of comorbidities in octogenarians may have a greater influence on outcomes post cardiac surgery than impaired renal function. Our data may provide a rationale for modified risk stratification in octogenarian candidates for cardiac surgery.     

Does off-pump coronary artery bypass grafting really preserve renal function?

It is well known that the use of cardiopulmonary bypass (CPB) influences renal function and occasionally results in renal failure following cardiac surgery. Coronary artery bypass grafting (CABG) without CPB may avoid this and preserve the perioperative renal function. The present study enrolled 52 patients undergoing CABG without CPB (OPCAB group) and matched them for renal function and prognostic variables with 53 patients undergoing conventional CABG (CABG group). Perioperative renal function and early clinical results were assessed. The OPCAB group had significantly less increase in creatinine levels (0.16 +/- 0.05 vs 0.45 +/- 0.06 mg/dl; p = 0.01) and greater creatinine clearance (81.6 +/- 7.3 vs 56.3 +/- 4.8ml/min; p = 0.01) postoperatively. Postoperative recovery of free water clearance was more prompt in the OPCAB group. The duration of intubation and intensive care unit stay was significantly shorter, and the creatine kinase-MB release and blood transfusion requirements were significantly less in the OPCAB group. The OPCAB technique preserved glomerular filtration rate and prevented the increase in creatinine levels. The results suggest that the technique enables earlier patient recovery and gives superior renal protection compared with conventional CABG.     

Leukodepletion improves renal function in patients with renal dysfunction undergoing on-pump coronary bypass surgery: a prospective randomized study

BACKGROUND: We aimed to show the impact of leukodepletion on renal function in patients undergoing on-pump coronary revascularization. PATIENTS AND METHODS: Fifty patients awaiting elective on-pump coronary revascularization with normal preoperative cardiac functions and with plasma creatinine levels ranging between 1.5 and 2.0 mg/dL were prospectively randomized into two groups: on-pump CABG with (group A: n = 25) and without leukodepletion (group B, n = 25). Renal glomerular and tubular injury were assessed by urinary alpha glutathione s-transferase (GST), plasma creatinine, and blood urea nitrogen (BUN) levels. RESULTS: The patients consisted of 14 females and 36 males with a mean age of 57.6 +/- 5.3 years. In the leukodepletion group, the mean levels of creatinine, BUN and urinary GST were found to be decreased on the first, third and fifth postoperative days compared with the control group. There was no mortality. Three patients in the control group needed postoperative dialysis. CONCLUSION: Patients with renal dysfunction undergoing on-pump CABG surgery seem to benefit from leukodepletion as a measure to prevent tubular damage and renal impairment compared with a control group.     

Prophylactic dialysis in elderly patients undergoing coronary bypass surgery

Renal dysfunction is associated with markedly increased risk for both mortality and morbidity in patients undergoing coronary artery bypass surgery (CABG), especially in elderly patients. In the current study, we aimed to determine the impact of prophylactic preoperative hemodialysis on operative outcome in patients with mild renal dysfunction. Between March 2002 and May 2005 a total of 64 patients, all of whom were more than 70 years of age and with preoperative creatinine levels greater than 2 mg/dL, underwent primary elective on pump coronary artery bypass surgery. The mean age was 76.3 +/- 6.4 (range 70-83). The patients were prospectively allocated into two groups. Group A was the dialysis group (31 patients) and preoperative prophylactic hemodialysis was carried out in all patients. Group B (33 patients) was taken as a control group without preoperative hemodialysis. During the present study, 10 patients died (15.6%) in the hospital. In the postoperative period mean levels of creatinine were found to be decreased in dialysis group. (2.3 +/- 0.8 mg/dL vs. 3.4 +/- 0.2 mg/, P = 0.037). The incidence of overall morbidity (such as acute renal failure, need of postoperative dialysis, low cardiac output and multiple organ failure) were also found to be decreased in dialysis group. We conclude from the present study that preoperative renal dysfunction and advanced age increase the risk of mortality and morbidity after on-pump coronary artery bypass surgery. We believe that perioperative prophylactic hemodialysis is an easy and effective method and it decreases both operative mortality and morbidity in elderly patients with renal dysfunction.     

The prognosis and risk factors for acute kidney injury in high-risk patients after surgery for type A aortic dissection in the ICU

BackgroundAcute kidney injury (AKI) is a major complication of cardiac surgery, with high rates of morbidity and mortality. The aim of this study was to identify risk factors for the incidence and prognosis of AKI in high-risk patients before and after surgery for acute type A aortic dissection (TAAD) in the intensive care unit (ICU).MethodsWe performed a retrospective cohort study from April 2018 to April 2019. The primary end points of this study were morbidity due to AKI and risk factors for incidence, and the secondary end points were mortality at 28 days and risk factors for death.ResultsWe enrolled 60 patients, 52 (86.67%) patients developed postoperative AKI, 28 (53.84%) patients died. Preoperative lactic acid level (P=0.022) and cardiopulmonary bypass (CPB) duration (P=0.009) were identified as independent risk factors for postoperative AKI. The 28-day mortality for postoperative patients with TAAD was 46.67%, 53.84% for those with TAAD and AKI, 67.5% for those who required continue renal replacement therapy (CRRT). The risk factors for 28-day mortality due to postoperative AKI for patients requiring CRRT were CPB duration (P=0.019) and norepinephrine dose upon diagnosis of AKI (P=0.037).ConclusionsMorbidity due to AKI in postoperative patients with TAAD was 86.67%, and preoperative lactic acid level and CPB duration were independent risk factors. The 28-day mortality of postoperative patients with TAAD was 46.67%, 53.84% for those with TAAD and AKI, and 67.5% for those requiring CRRT. CPB duration and norepinephrine dose upon diagnosis of AKI may influence patients’ short-term prognosis.     

体外循环与非体外循环下行CABG对肾功能不全患者肾功能影响的比较

目的:比较在体外循环与非体外循环下行冠状动脉旁路移植术（CABG）对患者肾功能的影响。方法: 我院40位择期行CABG的慢性肾功能不全患者,随机分为两组,每组20例,分别在在体外循环与非体外循环下行CABG。术前及术后1、3、7 d测定血肌酐值并计算肌酐清除率。结果: 体外循环组患者术后血肌酐值显著高于非体外循环组,其肌酐清除率较术前显著下降。结论:肾功能不全患者在体外循环与非体外循环下行CABG,前者更易加重肾功能损害。     

Predictors of prolonged mechanical ventilation after on-pump coronary artery bypass grafting

The predictors of prolonged mechanical ventilation and subsequent morbidity after cardiac surgery are ill defined. Our aim was to evaluate them. Four hundred and seventy consecutive patients undergoing coronary artery bypass grafting on cardiopulmonary bypass (CPB) between January and June 2002 were retrospectively analysed for preoperative predictors of prolonged ventilation, which included age, gender, ejection fraction (EF), renal function, diabetes, angina status, severity of the disease (New York Heart Association class), number of vessels diseased and chronic lung disease. Intraoperative variables such as prolonged CPB, aortic cross clamp time, intra-aortic balloon pump (IABP) usage, inotropes and postoperative variables like temperature on arrival at intensive care unit(ICU), IABP usage, organ dysfunction, inotropes and reintervention (reintubation and re-exploration) were also analysed. Prolonged ventilation was defined as > or = 24 hours and these patients were included in group I (n=22). Patients requiring less than 24 hours ventilation (n=448) were included in group II. Stepwise logistic regression analysis was performed. The average age of patients was 56.9 +/- 8.8 years with male predominance (88.4%). The overall perioperative mortality was 2.1% (10 patients) with Group I showing mortality rate of 36.3% (8 patients). In multivariate analysis, predictors of prolonged ventilation were found to be EF <40% (odds ratio, (OR) 13.38), preoperative renal dysfunction [OR 4.06 (serum creatinine > 1.2 mg%)], prolonged CPB, > 120 min (OR 9.6) and reintervention in the form of re-exploration or reintubation in the ICU (OR 13.8). Identification of perioperative variables, which may lead to prolonged ventilation may allow the development of strategies to optimize the patient's condition and ICU management.