心脏瓣膜置换术后肾功能改变的临床分析  

Clinical changes of renal function after heart valve replacement

作　　者：易俊[1] 景华[1] 朱家全[1] 董国华[1] 许飚[1] 罗立国[1] 顾卫东[1] 

机构地区：[1]南方医科大学南京临床学院(南京军区南京总医院)心胸外科,江苏南京210002

出　　处：《医学研究生学报》2006年第7期603-606,共4页Journal of Medical Postgraduates

基　　金：江苏省自然科学基金青年科技创新人才资助项目(批准号:BK2005431)

摘　　要：目的:探讨心脏瓣膜置换术后肾功能的变化及其相关影响因素。方法:回顾分析2003年1月至2005年11月在该科行瓣膜置换手术515例患者的临床资料,于手术前及手术后不同时间点测量血清肌酐(Cr),计算肾小球滤过率(GFR),观察其变化。并根据术后连续3 d的GFR值分为>80 m l/m in组和≤50 m l/m in组,比较和分析患者年龄、术前心功能分级和肾功能状况、CPB时间和围手术期低血压时间等因素与肾功能衰竭发生的相关性。结果:①术后3 d GFR均比术前降低,其差异有显著性意义(P<0.05)。术后7 d GFR逐渐恢复,与术前比较无显著性差异(P>0.05)。②术后50 m l/m in组的上述指标与>80 m l/m in组比较均有显著性差异(P<0.05或P<0.01)。结论:①CPB换瓣术后3 d内肾功能指标明显降低,第7 d逐渐恢复至术前水平。②高龄、术前心功能不全和肾功能损害、CPB时间长和围手术期低血压时间长是术后肾功能衰竭的主要相关危险因素。Objective：We aimed to explore the changes and the related factors of renal function after cardiac surgery with cardiopulmonary bypass （CPB）. Methods：Five hundred and Fifteen patients, who received heart valve replacement surgery from January 2003 to November 2005 in our department, were retrospectively analyzed. Serum creatinine of each patient was detected at pre operation （ T1 ）, and on days 1,2, 3, 7 post operation （T2, T3, T4, T5）, respectively. Glomerular filtration rate （GFR） was calculated using the Cockcroft - Gauh formula. Patients were divided into two groups based on post operational GFR 〉 80 ml/min or GFR ≤50 ml/min. Results：Compared with T1, GFR significantly decreased at T2, T3 and T4 after operation （P 〈 0.05 ） and gradually approached the preoperative level at T5 （P 〉 0.05 ）. The age, preoperative cardiac functional score, preoperative renal function, time of CPB and time of perioperative low blood pressure were significantly different （ P 〈 0.05 ） between the twogroups. Conclusion ：The renal function significantly decreased heart valve replacement with CPB, and then recovered gradually. function, pre-existing renal dysfunction, prolonged CPB time, risk factors of postoperative renal dysfunction. for the first three days in patients post Advanced age, poor preoperative heart low cardiac output syndrome were high risk factors of postoperative renal dysfunction.

关 键 词：心肺转流术 心脏瓣膜置换 肾功能 

分 类 号：R654.2[医药卫生—外科学]