体外循环和非体外循环冠脉搭桥术对患者肾功能的影响

目的研究体外循环和非体外循环冠脉搭桥术对肾功能的影响。方法24例接受冠脉搭桥术的患者分为两组,每组12例。A组为体外循环下冠脉搭桥组,B组为非体外循环下冠脉搭桥组。观察两组患者术前(T0)、手术结束(T1)、术后2 h(T2)和术后24 h(T3)时间点肾小球和肾小管功能的改变。结果体外循环冠脉搭桥组尿微量白蛋白与尿肌酐比值(m-A lb/Cr)、尿N-乙酸-β-D氨基葡萄糖苷酶(NAG)浓度组内各点相比,T1与T0比较差异有统计学意义(P<0.05)。非体外循环冠脉搭桥组尿m-A lb/Cr和NAG在T1时间点较体外循环冠脉搭桥组明显降低(P<0.05)。结论体外循环冠脉搭桥术可引起可逆性的肾功能早期损害。非体外循环冠脉搭桥术较体外循环冠脉搭桥术对肾功能损害明显减轻。

Effects of on-pump and off-pump coronary revascularization on renal function

Objective To investigate the effects of on-pump and off-pump coronary revascularization on renal function.Methods Twenty four patients underwent elective coronary revascularization were divided into 2 groups: group A with cardiopulmonary bypass(CPB)(n=12) and group B without CPB(n=12).Markers of glomerular and tubular function were evaluated before anesthesia(T_0),at the end of operation(T_1),2 hours after operation(T_2) and 24 hours after operation(T_3).Results The ratio of urinary microalbumin to creatinine and NAG levels increased significantly at T_1 as compared with that at T_0 in on-pump coronary revascularization(P<0.05).Off-pump coronary revascularization decreased the ratio of urinary microalbumin to creatinine and NAG as compared with on-pump surgery at T_1(P<0.05).Conclusion On-pump coronary surgery induces reversible renal damage both at the glomerular and tubular levels,whereas off-pump revascularization attenuates this damage.