作者：陈晨，陈园园，刘欣怡，尚星辰，祝娉婷

单位：

225009 江苏省扬州市，扬州大学护理学院 通信作者：祝娉婷，E-mail：ptzhu@yzu.edu.cn

Units：

School of Nursing, Yangzhou University, Yangzhou 225009, China Corresponding author: ZHU Pingting, E-mail: ptzhu@yzu.edu.cn

关键词：

急性肾损伤; 冠状动脉旁路移植术; 影响因素分析; Meta分析;

Keywords：

Acute kidney injury; Coronary artery bypass grafting; Root cause analysis; Meta-analysis

CLC：

DOI：

10.12114/j.issn.1008-5971.2021.00.294

Funds：

国家自然科学基金面上项目（82174129）；江苏省研究生科研与实践创新计划项目（KYCX20_3006）；江苏省人兽共患病学重点实验室“护馨基金”项目（HX2002）; 扬州大学“青蓝工程”（扬大人事〔2018〕44 号）

摘要：

背景冠状动脉旁路移植术(CABG)是临床治疗冠状动脉粥样硬化性心脏病的主要手术方式,急性肾损伤(AKI)是其常见的严重并发症之一。早期总结CABG患者并发AKI的危险因素对识别高危人群并制定干预措施具有重要意义,目前尚未见相关Meta分析及系统评价报道。目的采用Meta分析法探讨CABG患者并发AKI的影响因素,以期为预防CABG患者并发AKI提供循证依据。方法计算机检索PubMed、Embase、Cochrane Library及中国知网、万方数据知识服务平台、维普网、中国生物医学文献数据库,检索时限为建库至2021年6月。检索CABG患者并发AKI影响因素的相关文献。病例组为CABG后并发AKI患者,对照组为CABG后未并发AKI患者。收集患者一般因素、客观指标、疾病类型、手术因素进行Meta分析。采用漏斗图分析纳入相关指标的文献是否存在发表偏倚。结果最终纳入25篇文献,包含16 035例患者,其中对照组11 959例,病例组4 076例。Meta分析结果显示,两组患者年龄、体质指数(BMI)、血肌酐(Scr)水平、估算肾小球滤过率(eGFR)、欧洲心血管手术危险因素评分系统(EuroSCORE)评分、血红蛋白水平、心肌梗死发生率、高血压发生率、高脂血症发生率、慢性阻塞性肺疾病(COPD)发生率、卒中发生率、糖尿病发生率、急诊手术者占比、输血率、主动脉阻断时间、主动脉内球囊反搏术(IABP)治疗率、旁路移植数量、机械通气时间、体外循环(CPB)时间、ICU入住时间比较,差异有统计学意义(P <0.05)。漏斗图分析结果显示,报道年龄、男性占比、BMI、左心室射血分数、Scr水平、心肌梗死发生率、高血压发生率、糖尿病发生率、急诊手术者占比、IABP治疗率、CPB时间文献的数据点基本对称均匀,且所有数据点分布于漏斗图内部,提示上述文献发表偏倚较小。结论本Meta分析结果显示,年龄、BMI、Scr水平、eGFR、EuroSCORE评分、血红蛋白水平、心肌梗死、高血压、高脂血症、COPD、卒中、糖尿病、急诊手术、输血、主动脉阻断时间、IABP、旁路移植数量、机械通气时间、CPB时间、ICU入住时间可能是CABG患者并发AKI的影响因素。

Abstract：

【Abstract】　Background Coronary artery bypass grafting (CABG) is the main surgical method for coronary heartdisease in clinic, and acute kidney injury (AKI) is one of its common and minor complications. Therefore, it is necessary to explorethe risk factors of AKI in patients with CABG, so as to identify high-risk patients and formulate intervention. No relevant metaanalysis or systematic reviews has been reported so far.Objective To explore the influencing factors of AKI in patients withCABG via meta-analysis, so as to provide evidence for the prevention of AKI in patients with CABG.Methods Electronicdatabases which included PubMed, Embase, Cochrane Library, CNKI, Wanfang Data, VIP, CBM were searched from inception toJune 2021. The related literature of influencing factors of AKI in CABG patients were searched. The case group was the patientswith AKI after CABG, and the control group was the patients without AKI after CABG. General factors, objective indicators, typeof disease and surgical factors of patients were collected for meta-analysis. Funnel plot was used to analyze whether there waspublication bias in the literature included in relevant indicators. Results Finally, a total of 25 articles were recruited, including16 035 cases of patients, among them, there were 11 959 cases in the control group and 4 076 cases in the case group. Metaanalysis results showed that there were statistically significant differences in age, body mass index (BMI) , serum creatinine (Scr) level,estimated glomerular filtration rate (eGFR) , European System for Cardiac Operative Risk Evaluation (EuroSCORE) , hemoglobinlevel, incidence of myocardial infarction, incidence of hypertension, incidence of hyperlipidemia, incidence of chronic obstructivepulmonary disease (COPD) , incidence of stroke, incidence of diabetes, proportion of emergency surgery, blood transfusion rate,aortic occlusion time, intra-aortic balloon pump (IABP) treatment rate, number of bypass transplants, mechanical ventilationtime, cardiopulmonary bypass (CPB) time, ICU stay time between the two groups (P < 0.05) . Funnel plots analysis showed that,the data points of articles which reported age, male proportion, BMI, left ventricular ejection fraction, Scr level, incidence ofmyocardial infarction, incidence of hypertension, incidence of diabetes, proportion of emergency surgery, IABP treatment rate,CPB time were basically symmetrical and uniform, and were evenly distributed in the funnel plot, indicated that the publicationbias of above articles was small. Conclusion The results of this meta-analysis show that age, BMI, Scr level, eGFR, EuroSCOREscore, hemoglobin level, myocardial infarction, hypertension, hyperlipidemia, COPD, stroke, diabetes, emergency surgery, bloodtransfusion, aortic occlusion time, IABP, number of bypass grafts, mechanical ventilation time, CPB time, ICU stay time may bethe influencing factors of AKI in patients with CABG.

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