BackgroundThe atherogenic index of plasma (AIP) and hyperuricemia (HUA) have been shown to be closely associated with morbidity and mortality of coronary artery disease. However, studies targeting predictive value of AIP and HUA for chronic total occlusion (CTO) lesions are still lacking.MethodsIn total, 5,238 patients meeting the eligibility criteria were recruited in this analysis. CTO was defined as the condition of lesions without forward blood flow and with over three months of occlusion time. AIP was calculated as log10 [triglycerides (mmol/L)/high-density lipoprotein cholesterol (mmol/L)]. HUA was defined based on sex-specific criteria: serum uric acid 420 and 360 μmol/L for males and females, respectively.ResultsCTO lesions were presented in 907 (17.3%) patients. Compared with patients showing lower AIP levels and non-HUA, the CTO lesion risks increased by 5.225 and 2.765 times in patients with higher AIP levels and HUA. Patients with AIP >0.15 and HUA exhibited the greatest CTO incidence (odds ratio 11.491; 95% confidence interval 9.019–14.641, P < 0.001). In addition, AIP combined with HUA had significantly increased effects (a 38.5% increase in CTO risk) relative to the sum of respective effects.ConclusionPatients having higher AIP levels and HUA exhibited the highest CTO incidence, in comparison with patients who have the increased single index. AIP combined with HUA displayed significant synergistic effect on the prediction of CTO lesion.

Background The number of patients with chronic diseases in the community of China is increasing annually.Family doctor contract service is an important way to promote people's health in China,and long-term family doctor contract will help to improve the continuity of health management and the treatment outcomes.Analyzing patient demand for long-term family doctor contract is critical to the advancement of family medicine services in China.Objective To investigate the demand for long-term family doctor contract among community patients in Beijing Chaoyang Distrct and analyze its influencing factors,so as to provide a theoretical basis for achieving high quality family medicine services.Methods Using continuous enrollment,500 patients who were enrolled in family doctor contract service at Baliqiao community health service center,Taiyanggong community health service center and Jiangtai community health service center in Chaoyang District,Beijing from January 2020 to January 2021 were included as the study subjects and categorized into the agreement group(those willing to sign long-term contracts)and the refusal group(those unwilling to sign long-term contracts).Data on patient demographics,chronic diseases,educational level,income status,medical expenses,health status,distance from home to the community health service center,compliance,living arrangements,and other indicators were collected through online system retrieval of health records and supplemented by questionnaire surveys from January 2020 to January 2021.From January to March 2021,a questionnaire survey was conducted to collect general information,service quality evaluation,and willingness to sign long-term family doctor contracts.The SERVQUAL scale was designed based on literature retrieval,expert consultation,and preliminary open-ended questionnaire survey results to evaluate the quality of family doctor services.Scores were assigned for expected quality,perceived quality,and importance,ranging from 1 to 5.Expectation scores and perception scores were used to calculate the service quality(SQ)score,and the latter was used to correct importance and calculate the corrected SQ(cSQ)score.Multivariate Logistic regression analysis was used to explore the influencing factors of the demand for long-term family doctor contract services.Results A total of 500 questionnaires were distributed,and 423 were collected,including WeChat platform(73,17.2%),offline questionnaire(190,44.9%)and telephone interview(160,37.8%),the validity rate was 84.6%.Among the respondents,283 belonged to the agreement group(66.9%),and 140 belonged to the refusal group(33.1%).The average score for the SERVQUAL scale was-0.54,with perceived and expected average scores of 3.98 and 4.52,respectively.Statistically significant differences were observed in the cSQ scores and average scores for each dimension between the two groups(P<0.05).The results of multivariate Logistic regression analysis showed that distance from home to the community health service center(OR=1.077,95%CI=1.013-1.145,P=0.018),compliance(OR=0.291,95%CI=0.137-0.617,P=0.001),living alone(OR=4.132,95%CI=1.997-8.550,P<0.001),and cSQ(OR=0.983,95%CI=0.980-0.986,P<0.001)were independent influencing factors for patients'willingness to sign long-term family doctor contracts.Conclusion The corrected family doctor service quality,distance from home to community health service center,living arrangements,and compliance are independent factors influencing patients'willingness to sign long-term family doctor contracts.The SERVQUAL scale can effectively evaluate family doctor service quality and aids in developing strategies for improving family doctor services.

近年来,冠心病合并抑郁的情况日益受到关注.研究[1-3]表明,冠心病人群中抑郁患病率显著高于普通人群,且冠心病合并抑郁不仅影响了患者的生活质量,也给社会带来一定的经济负担.在经皮冠状动脉介入治疗术后的定期随访中发现,抑郁与更高的不良反应风险以及更高的全因死亡率等临床结局相关[4-5].冠心病合并抑郁的机制可以分为生物学机制和社会心理行为机制等.生物学机制包括炎症机制、内分泌机制、异常血小板活化以及内皮功能障碍等.社会心理行为机制包括缺乏运动、吸烟等不健康生活方式、人格因素和社会因素等.现主要就冠心病合并抑郁机制方面的最新进展进行综述,以期为冠心病合并抑郁患者的诊治提供思路.

背景 全科医学专业研究生导师肩负着培养未来全科医学专业人才的重任，全科医学专业研究生导师自身的医患沟通能力对全科医学事业发展至关重要。目的 探讨全科医学专业硕士生导师在门诊接诊过程中的医患沟通能力现状。方法 2022 年 4—6 月，采用整群抽样法，选择来自首都医科大学的全科医学专业硕士生导师 75 例作为测评对象。测评人员作为同行者参与门诊患者就诊全过程，按照医患沟通技能评价量表（SEGUE）对全科医学专业硕士生导师在门诊接诊过程中的医患沟通能力进行测评。将全科医学专业硕士生导师 SEGUE 总得分及各维度得分与前期接受测评的三级医院专家门诊医生和社区卫生服务中心全科医生的测评结果进行比较，分析不同性别、任职方式的全科医学专业硕士生导师 SEGUE 总得分及各维度得分的差异性，比较全科医学专业硕士生导师与美国通科医生的SEGUE 总得分。结果 75 例全科医学专业硕士生导师 SEGUE 总得分为 12~24 分，平均总得分为（17.8±2.6）分；在准备、信息收集、信息给予、理解患者和结束问诊维度上的平均得分分别为（3.9±0.9）、（6.5±1.7）、（3.1±1.1）、（2.6±0.9）、（1.7±0.5）分。全科医学专业硕士生导师、社区卫生服务中心全科医生在 SEGUE 准备和结束问诊维度上的得分高于三级医院专家门诊医生（P<0.05）；就职于一级医院的全科医学专业硕士生导师 SEGUE 总得分及在准备维度上的得分高于就职于二级医院的全科医学专业硕士生导师（P<0.05），就职于一级医院的全科医学专业硕士生导师 SEGUE 总得分及在准备、信息收集维度上的得分高于就职于三级医院的全科医学专业硕士生导师（P<0.05）；全科医学专业硕士生导师 SEGUE 总得分低于美国通科医生（P<0.05）。结论 全科医学专业硕士生导师的临床沟通能力仍有较大提升空间，其临床沟通能力低于美国通科医生。全科医学院（系）的教学管理部门应重视对全科医学专业研究生导师医患沟通能力的培养，并让其通过言传身教提高全科医学专业研究生的人文医学执业技能水平。

Objective:To explore the intervention effect of humanistic management on anxiety and depression tendency of visiting physicians.Methods:The visiting physicians who began to further study in Beijing Anzhen Hospital, Capital Medical University from January 2016 to December 2018 were selected for humanistic management, and the visiting physicians from April 2013 to December 2015 were set as reference to conduct a questionnaire survey before and after the refresher training with the Hospital Anxiety and Depression Scale. Therefore, the visiting doctors all had the conventional refresher study management mode. On this basis, the intervention group established an individualized refresher study schedule, equipped the doctors with tutors, regularly visited the doctors and organized symposiums for them, assisted them to join the academic groups of the department, organized and coordinated the doctors to participate in the multi-disciplinary academic ward rounds, conducted negative emotional relief through the Balint groups, and integrated the cultural life of the refresher doctors into the cultural construction of the hospital and follow up the refresher doctors after the refresher training. SPSS 16.0 was used to perform t-test and variance analysis. Results:There was no difference in anxiety and depression scores between the two groups according to gender, type of refresher department, level of source hospital and length of study ( P > 0.05). Compared with the two evaluations in the intervention group, the second scores of anxiety for men and women [(5.90±1.37) vs . (6.48±1.87), (5.92±1.45) vs . (6.73±2.12)], doctors in each department [(5.50±1.23) vs . (6.76±2.35), (6.03±1.36) vs . (6.64±1.75), (5.98±1.50) vs . (6.64±2.15)], doctors from secondary and tertiary hospitals [(5.85±1.29) vs . (6.64±2.02), (6.00±1.50) vs . (6.78± 2.14)], the total score of doctors [(5.92±1.37) vs . (6.64±2.15), (5.92±1.47) vs . (6.68±1.98)] and the total score [(5.92±1.42) vs. (6.66±2.05)] were lower than the first evaluation score ( P<0.05). The second scores of depression for female doctors [(6.15±1.37) vs . (6.68±2.06)], doctors in medical laboratory department [(6.02±1.40) vs . (6.69±1.88)], doctors from tertiary hospital [(6.13±1.41) vs. (6.51±1.90)], doctor with different training durations [(6.04±1.42) vs . (6.50±2.02), (6.12±1.34) vs . (6.57±1.97)] and the total score of doctors [(6.09±1.37) vs . (6.54±1.99)] were lower than those of the first evaluation ( P < 0.05). The anxiety score of the second evaluation in the control group was higher in male physicians [(6.63±1.15) vs . (6.11±1.76)] than the first evaluation ( P < 0.05). Compared with the second evaluation data of doctors in the two groups, in terms of anxiety scores, the scores of doctors at all levels and total scores in the intervention group were lower than those in the control group ( P < 0.05); in terms of depression score, the scores of female visiting doctors, doctors from tertiary hospitals, doctors with refresher training duration of 6 months and total score were lower than those of the control group ( P < 0.05). Conclusion:The application of humanistic management to strengthen the management of refresher physicians can improve the psychological state of refresher doctors to a certain extent, especially alleviate the anxiety state, which is a worthy promotion of refresher management mode.

Objective To explore the relationship between stress hyperglycemia ratio（SHR） and acute kidney injury（AKI） in patients with acute myocardial infarction（AMI）. Methods From January 2020 to February 2021, the patients with AMI admitted to Beijing Anzhen Hospital, Capital Medical University were continuously collected, and they were divided into AKI group and non-AKI group according to whether AKI occurred in the hospital. SHR and other clinical data were compared between the two groups. Logistic regression method was used to analyze the risk factors of AKI in AMI patients. Results A total of 856 patients with AMI were included in this study, including 146 patients with AKI in the hospital（AKI group）, accounting for 17.1%, and 710 patients without AKI（non-AKI group）. The age, proportions of chronic kidney disease, old cerebral infarction, Killip grade≥3, the levels of blood urea nitrogen, serum creatinine, plasma glucose immediately after admission, SHR, cardiac troponin, brain natriuretic peptide, and the proportions of taking respirator, diuretic, positive inotropic drugs in AKI group were higher than those in non-AKI group, and the albumin, estimated glomerular filtration rate, left ventricular ejection fraction（LVEF）, the proportion of emergency percutaneous coronary intervention, and total amount of contrast agent were lower than those in non-AKI group（all P＜0.05）. The length of stay, incidence rate of hospital cardiogenic shock and fatality rate in AKI group were higher than those in non-AKI group [8（5,14）d vs 6（5,9）d, 8.2%（12/146） vs 0.8%（6/710）, 24.0%（35/146） vs 9.0%（64/710）]（all P＜0.001）. Multivariate Logistic regression analysis showed that SHR（odds ratio=5.35, 95% confidence interval: 3.17-9.27, P＜0.001）, ventilator use, age and chronic kidney disease were independent risk factors for AKI in AMI patients, and LVEF was a protective factor for AKI in AMI patients（all P＜0.05）. The plasma glucose immediately after admission and fasting plasma glucose were excluded. In the subgroup analysis of diabetic and non-diabetic AMI patients, SHR was an independent risk factor for AKI, respectively（both P＜0.05）, while the plasma glucose immediately after admission and fasting plasma glucose were excluded. Conclusion SHR is an independent risk factor for AKI in AMI patients.

目的 探究卡格列净联合西格列汀在老年2型糖尿病患者中的应用效果.方法 选取2020 年1-12 月在首都医科大学附属北京安贞医院接受治疗的132 例老年2 型糖尿病患者为研究对象,经随机数字表法分为对照组和观察组,各66 例.对照组在饮食、运动等常规干预基础上采用二甲双胍治疗;观察组在对照组基础上采用卡格列净联合西格列汀治疗.比较 2 组血糖指标、空腹及餐后 2hC肽、尿微量白蛋白水平以及体质量、腰围、腹围、体重指数和不良反应.结果 治疗后,观察组空腹血糖、餐后 2h血糖、糖化血红蛋白[(5.9±0.8)%比(6.2±0.8)%]、空腹C肽、餐后2hC肽、尿微量白蛋白水平低于对照组,差异均有统计学意义(均P<0.05).治疗后,观察组体质量[(62±6)kg比(65±6)kg]、腰围、腹围、体重指数低于对照组,差异均有统计学意义(均P<0.05).观察组不良反应发生率低于对照组[7.6%(5/66)比19.7%(13/66)],差异有统计学意义(P<0.05).结论 卡格列净联合西格列汀对老年2 型糖尿病患者进行治疗的效果显著,可有效控制患者血糖水平,降低尿微量白蛋白等相关指标,安全性较高.

冠心病(冠状动脉粥样硬化性心脏病)与焦虑关系密切,焦虑情绪可以影响冠心病的发展和预后,严重威胁人类身心健康,及时评估冠心病患者心理状态并采取针对性干预措施至关重要.本文就冠心病合并焦虑的影响因素,以及认知行为疗法、生物反馈疗法、中医治疗等干预疗法的最新研究进展进行综述,以期加深临床医师对冠心病合并焦虑的认识,为临床诊治提供参考.

目的 探讨医患沟通技巧培训对提高医学本科生医患沟通技能的效果.方法 选择首都医科大学第六临床医学院2017级五年制医学本科生57人为研究对象,在大学四年级时进行医患沟通技巧培训.培训前后应用医患沟通技能评价量表(SEGUE)进行测评,比较其沟通技能的变化.结果 培训后,医学本科生准备阶段、信息收集、信息给予、结束问诊维度得分和SEGUE总分均有显著提升(P<0.05),但与美国通科医生相比仍存在差距.结论 对医学本科生进行医患沟通技巧培训,可以显著提高其医患沟通技能水平,值得在国内医学院校推广.

在中国,对冠心病的医疗保健一直侧重于治疗,而对接受治疗的患者的随访很少.尤其是血管重建术后(冠状动脉介入/旁路移植,PCI/CABG)的患者.同时,根据世界卫生组织公布的数据显示,1990年至2019年间,心血管疾病患病率稳步增长,几乎翻了一番.2019年全球死亡人数中,1/3死于心血管疾病,其中中国是心血管疾病死亡人数最多的国家.在心源性死亡病例中,其中大部分可归因于可改变的危险因素.

应用自编的《临床医学专业学位研究生人文素质调查问卷》,对临床医学研究生的人文知识、人文理念、人文方法、人文精神和对学校人文素质教育认可程度的现状进行调查.结果显示,现阶段临床医学专业学位研究生人文素质有待进一步提高,而加强临床医学研究生人文课程体系建设和实践能力训练、积极营造浓厚的校园和医院人文素养文化氛围、提高临床研究生授课教师和导师的人文素质是可行的解决方案.

目的 探讨人文医学执业技能培训对提高护理学专业学生(以下简称护生)护患沟通能力的干预效果.方法 选择北京卫生职业学院2015级和2016级在北京安贞医院实习的护生作为研究对象,将进行人文医学执业技能培训的2016级护生作为实验组,2015级护生作为对照组,采用护理学专业学生护患沟通能力评价量表进行测评.结果 两组护生第1次测评量表各维度得分及总分比较差异无统计学意义;实验组第2次测评量表各维度得分及总分均高于第1次测评及对照组;对照组两次测评量表各维度得分及总分比较差异无统计学意义.结论 人文医学执业技能培训能够提高护生的护患沟通能力,值得进一步推广.

背景 冠状动脉旁路移植术已经成为治疗冠心病的重要方法 ,随着手术技术和器械的改进,国内每年接受该手术的患者逾30000例,且数量持续增加.既往医生对术后患者更多的关注其生理指标的康复效果,而忽视了患者心理康复的相关问题.目的 探讨运动干预对非体外冠状动脉旁路移植术(OPCAB)后中年患者健康相关生存质量(HRQOL)的影响.方法 选择2014年1月—2017年6月在首都医科大学附属北京安贞医院心脏外科单一手术组行OPCAB的中年患者348例作为研究对象,并按照术后6～18个月是否能够达到运动标准分为运动组(144例)和对照组(204例).于术后6个月和18个月分别测定患者的射血分数(EF)及左心室舒张末期内径(LVEDD),并应用简明健康调查量表(SF-36)进行测评,记录生理机能(PF)、生理角色限制(RP)、躯体疼痛(BP)、总体健康(GH)、活力(VT)、社会功能(SF)、情感角色限制(RE)、心理健康(MH)、生理健康内容(PHC)、心理健康内容(MHC)评分及SF-36总分,比较两组间术后6个月及术后18个月各指标间有无差异.结果 术后6个月,两组间EF、LVEDD、PF评分、RP评分、BP评分、GH评分、VT评分、SF评分、RE评分、MH评分、PHC评分、MHC评分、SF-36总分比较,差异均无统计学意义(P>0.05).术后18个月,运动组EF、PF评分、RP评分、BP评分、GH评分、VT评分、SF评分、RE评分、MH评分、PHC评分、MHC评分、SF-36总分均高于对照组(P<0.05);术后18个月,两组间LVEDD比较,差异无统计学意义(P>0.05).对照组及运动组术后18个月的EF、PF评分、RP评分、BP评分、GH评分、VT评分、SF评分、RE评分、MH评分、PHC评分、MHC评分、SF-36总分均高于术后6个月,LVEDD低于术后6个月(P<0.05).结论 达标的运动干预可以明显提升OPCAB后中年患者的HRQOL.

目的通过大鼠右心室心肌成纤维细胞(RVCFs)体外培养,探讨血管紧张素(Ang)-(1-7)及丝裂原活化蛋白激酶激酶抑制剂U0126对Angll诱导的RVCFs的影响.方法提取乳大鼠RVCFs,经过抗波形蛋白免疫荧光法鉴定,传代培养至第3代,随机分为对照组、Ang II组、Ang-(1-7)组(分为低、中、高剂量组)、U0126组(分为低、中、高剂量组).采用噻唑蓝比色法测定各组细胞增殖情况;蛋白质印迹法检测各组I型胶原蛋白αl(COLIAl)表达水平;免疫组织化学法测定转化生长因子β1(TGF-β1)表达水平.结果Ang II组RVCFs的细胞增殖率明显高于对照组[(141.7 ± 9.6)％比(100.0 ± 0.0)％],Ang-(l-7)低、中、高剂量组,U0126低、中、高剂量组RVCFs的细胞增殖率[(118.2 ±4.9)％、(52.1 ± 5.9)％、(43.6 ±2.5)％,(43.0±2.3)％、(43.3 ±3.7)％、(49.4 ±4.6)％]均显著低于Angll组(均P<0.05),且Ang-(l-7)对RVCFs增殖的抑制作用呈剂量反应关系.Ang Ⅱ能促进RVCFs COL1A1表达,Ang-(1-7)及U0126对Ang II诱导的COL1A1表达均有抑制作用.TGF-β1免疫组化阳性反应分级示对照组(+)、Ang11组(+++)、Ang-(l-7)组(++)、U0126组(+).结论 Ang-(1-7)、U0126可部分抵消Angll刺激导致的RVCFs 增殖,抑制TGF-β1和COL1Al的蛋白表达.

目的:探讨期望值管理对心脏外科患者术后满意度干预效果.方法:选择首都医科大学附属北京安贞医院心脏外科单一病房201 8年1～12月行心脏外科手术患者382人,按照诊疗组医生在患者术前是否对其及家属进行期望值管理分为干预组和对照组.对照组患者术前由手术组医生常规签署《知情同意书》,干预组进行期望值管理.结果:术后1年门诊随访,干预组满意度得分高于对照组(P＜0.05),副主任医师沟通后的患者满意度得 分高于住院医师和主治医师(P＜0.05),住院医师沟通时间短于主治医师和副主任医师(P＜0.01).结论:通过手术前对心脏外科患者进行有效的期望值管理,可以明显提高患者术后满意度.

Objective:To investigate the incidence of acute kidney injury (AKI) following cardiac surgery and related risk factors in 4 878 patients.Methods:The information from patients who underwent cardiac surgery through March 2015 to October 2015 was collected retrospectively from the electronic database of Beijing Anzhen Hospital. A total of 4 878 patients were divided into AKI group and non-AKI group according to whether AKI occurred within 7 days after cardiac surgery. The incidence of AKI was calculated, and the AKI incidence in different types of cardiac surgeries were compared. Clinical data such as baseline clinical information, operation information, comorbidity, hospital stay time, life ability score in discharge from the hospital, and so on, were compared between AKI group and the non-AKI group using univariate analysis. Risk factors for AKI following cardiac surgery were analyzed using the binary multivariate logistic regression.Results:A total of 933 patients suffered from AKI (19.1%) following cardiac surgery. The time of stay in the hospital was longer in AKI group than that in the non-AKI group [(14.4±8.9) vs (13.7±7.7) d, P<0.05)]. The incidence of AKI in different types of cardiac surgeries varied significantly ( P<0.001). The logistic regression analysis showed that male, diabetes, hypertension, the elevated basic serum creatinine, cardiac dysfunction (NYHA grade≥Ⅲ), cardiopulmonary bypass, a combination of operations≥3, the rethoracotomy exploration and hemostasia, and using an invasive ventilator for over 96 hours were the independent risk factors for the AKI following cardiac surgery (all P<0.05), and the odds ratio (95% confidence interval) were 1.81(1.46-2.24), 1.29(1.03-1.62), 5.85(4.73-7.22), 1.81(1.36-2.40), 4.49(3.60-5.60), 1.84(1.49-2.27), 23.24(18.25-29.59), 2.34(1.45-3.77) and 1.94(1.09-3.43) respectively. Conclusions:The incidence of AKI after cardiac surgery in Beijing Anzhen Hospital is 19.1%. AKI following cardiac surgery prolongs the time of stay in the hospital. Independent risk factors for AKI following cardiac surgery are multiple, and one of the most critical factors is a combination of operations≥3.

目的:探讨运动对非体外冠状动脉旁路移植术后患者焦虑抑郁状态干预效果.方法:选择2018年1月至2019年6月,在北京安贞医院心脏外科单一手术组行非体外冠状动脉旁路移植术的患者258例,按照其术后6～ 12个月是否运动达标分为运动组和对照组,于术后6个月和12个月分别应用医院焦虑抑郁量表进行测评.结果:运动组患者术后12个月焦虑[(6.63±1.27)vs.(6.20±1.18),t=2.462,P=0.015]和抑郁[(6.05±0.93)vs.(5.67±1.05),t=2.683,P=0.008]得分低于术后6个月;术后12个月两组比较,运动组焦虑得分[(6.20±1.18)vs.(6.66±1.06),t=-3.262,P=0.001]低于对照组.结论:对于行非体外冠状动脉旁路移植术术后患者,达标的运动干预可以明显缓解患者的焦虑状态.

There is a high incidence of anxiety and depression among patients after percutaneous coronary intervention(PCI).Anxiety and depression are independent predictors of major adverse cardiovascular events and death following PCI.The pathogenesis of anxiety and depression in post-PCI patients is mainly associated with the interception of neurotransmitters in brain's limbic system-striatum-thalamic loop.Risk factors of post-PCI anxiety and depression are gender,age,education,financial status,as well as the severity of coronary lesion and type D personality,etc.Major treatments include psychological intervention,nursing care,traditional Chinese medicine and western medicine.

目的 研究术前糖化血清白蛋白(GA)水平对冠状动脉旁路移植术(CABG)患者术后急性肾损伤(AKI)发生风险的影响.方法 回顾性分析2015年3-10月入住首都医科大学附属北京安贞医院心脏外科2 644例行CABG患者的病历资料.根据患者术后7d内是否发生AKI分为AKI组及非AKI组.采用单因素及多因素Logistic回归分析CABG患者术后发生AKI的危险因素.结果 行CABG的2 644例患者中548例术后发生AKI,总AKI发生率为20.7％.多因素Logistic回归分析结果显示,GA≥21％、术前血肌酐增高、合并高血压、纽约心脏病协会心功能分级≥Ⅲ级、体外循环、联合多项手术为CABG手术后发生AKI的独立危险因素(比值比=1.778、1.748、11.713、14.252、2.359、750.660,95％置信区间:1.171～2.701、1.035～2.952、7.823～ 17.536、9.654 ～21.040、1.620～3.436、342.546～1 645.006,均P＜0.05),而女性是保护性因素(比值比=0.544,95％置信区间:0.386～0.768,P=0.001).结论 本研究收集的资料中CABG患者术后AKI发生率为20.7％,术前GA≥21％是术后AKI发生的独立危险因素.