摘要
目的研究体外循环与微创冠状动脉搭桥术对肾功能的影响。方法适合冠状动脉搭桥术患者42例,随机分成C(体外循环,CCABG)组和O(微创术,OPCABG)组各21例。分别留取术前24 h(T0)、术中(T1)、术后24 h(T2)、术后48 h(T3)四个时段的尿液及血液标本,记录尿量,通过血、尿标本中的肌酐测定结果计算内生肌酐清除率(C cr);同时检测尿微量白蛋白(ALB)、尿视黄醇结合蛋白(RBP)、N-乙酰-β-D-氨基葡萄糖苷酶(NAG)浓度,计算尿蛋白或酶排量(蛋白或酶浓度与C r之比)。结果①C cr:两组病人T1明显高于T0,T2、T3快速回降低于T0(P<0.01)。组间比较,T1C cr水平C组明显高于O组,T2、T3C cr水平C组明显低于O组(P<0.05);②尿ALB/C r:两组病人T1ALB/C r值明显高于T0水平,T2、T3有不同程度的回落,但仍高于T0(P<0.01)。T1ALB/C r,C组明显高于O组(P<0.01);③尿RBP/C r、NAG/C r:T0两组病人尿RBP/C r、NAG/C r水平均高于正常值,并在T1-T3各时点持续上升高于T0(P<0.01)。两组T1、T2、T3各相应时点值比较,C组明显高于O组(P<0.01,P<0.05)。结论微创术与非体外循环对肾小球和肾小管功能均有可逆的亚临床影响,对肾小管影响大于肾小球。微创术对肾功能的影响较小于体外循环的影响。
Objective To study effect on renal function between conventional coronary artery bypass grafting and off-pump conventional coronary artery bypass grafting. Methods A prospective, randomized, controlled trial was performed in 42 patients as by indicated for elective coronary artery bypass （CCABG or OPCABG）. Patients urine was collected for creatinine clearance measurement （urine,blood creatine content and urine volume） at four intervals,including 24 hours before the operations,the entire period of the operation,24 hours and 48 hours postoperations. The serum and urine were separated and analyzed as soon as creatinine clearance. The detections of urinary ALB,RBP and NAG then the urine protein or enzyme/creatinine ratio was calculated respectively. Results ①Ccr levels increased significantly during operation at T1 in both groups as compared with the preoperative levels （T0） ,but decreased quickly to under the baseline values after operation at T2 and T3 （P〈0. 01）. Comparing the two groups,Ccr leves was significantly higher at T1 ,where significantly lower after operation at T2,T3 in group C than in group O（P〈0. 05）. ②The urinary ALB/Cr increased significantly during operating at T1 in both groups and decreased at different extent after operation at T2 and T3,but were both significantly higher than preoperative levels（P〈0. 01）. ALB/Cr was significantly higher in group C than in group O during operation at T1 （P 〈0. 01）. ③The preoperative urinary RBP/Cr and NAG/Cr were higher than normal at To and kept increasing at T1-T3 as compared with the baseline values （T0） in both groups （P〈0. 01）. The urinary RBP/Cr and NAG/Cr in group C were significantly higher than those in group O at the corresponding points （P〈0. 01,P〈0. 05 respectively）. Conclusion Both CCABG and OPCABG resulted in reversible subclinical renal glomerulus and worse tubular injury. In contrast to CCABG, OPCABG induced much milder renal function injury.
出处
《现代检验医学杂志》
CAS
2006年第2期31-33,共3页
Journal of Modern Laboratory Medicine
关键词
体外循环
微创术
肾功能
conventional coronary artery bypass grafting
off-pump conventional coronary artery bypass graftlng
renal function
