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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
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術後の腎機能障害/腎不全のリスク指数:脈圧高血圧に対する重大な依存度
Solomon Aronson1, Manuel L Fontes, Yinghui Miao
1Duke University Medical Center, Durham, NC, USA. diane@iref.org
Circulation
|February 7, 2007
まとめ
冠動脈バイパス移植手術後の急性腎臓損傷は一般的で高価です. 術前脈圧は,年齢や心臓病とともに,腎臓合併症の新たな独立リスク因子である.
科学分野:
- 心血管外科手術についてです.
- ネフロロジーは腎臓科
- クリティカルケア・メディシン
背景:
- 冠動脈バイパス移植手術 (CABG) の後の急性腎臓損傷は,高い死亡率と医療費の増加に関連しています.
- 修正可能および修正不能の危険因子を特定することは,患者のアウトカムを改善するために極めて重要です.
研究 の 目的:
- CABG後の手術後の腎複合症 (腎機能不全および/または腎不全) の独立したリスク要因を特定する.
- これらの腎疾患を予測するためのリスクインデックスを開発し,検証する.
主な方法:
- 心肺バイパスによるCABGを受ける4801人の患者を対象とした前向きな記述的研究.
- 2381人の患者のコホートにおける予測変数の分析と,2420人の患者の別のコホートにおける検証.
- リスク因子と手術後の腎疾患との関連性を確認するための統計分析.
主要な成果:
- 術後の腎臓複合症の総発生率は4.8% (231人の患者) であった.
- 独立した危険因子には,高齢 (>75歳),閉塞性心力不全,前回の心筋梗塞,既往の腎疾患,手術中のイノトロップ使用,大動脈内気球ポンプ挿入,長期心肺バイパス (>2時間),および手術前の高脈圧が含まれています.
- 40mmHg以上のパルス圧の20mmHgの上昇は,腎臓複合症の確率1.49倍増加 (P=0.001) と関連していました.
- 脈圧高血圧 (>80mm Hg) の患者は,腎臓関連の死亡のリスクが3倍に増加しました.
結論:
- 確立されたリスク要因は,CABG後の腎臓合併症を有意に予測します.
- 術前脈圧は,手術後の腎臓複合体の独立かつ有意な予測指標であり,リスク評価におけるその重要性を強調しています.
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