肾动脉支架术在需行冠状动脉旁路术的合并肾动脉狭窄患者的应用  

The application of renal artery stenting for patients with coronary atery heart disease and renal artery stenosis needing coronary atery bypass graft

作　　者：王人彭[1] 朱国英[1] 万海燕[1] 苏晞[1] 彭剑[1] 宋丹[1] 陈国洪[1] 陈运清[1] 

机构地区：[1]武汉亚洲心脏病医院,徐州市第三人民医院430022

出　　处：《中国介入心脏病学杂志》2006年第5期289-291,共3页Chinese Journal of Interventional Cardiology

摘　　要：目的为防止冠状动脉旁路术(CABG)术后发生急性肾功能不全,对需行CABG合并肾动脉狭窄患者行肾动脉支架治疗。方法自2001年4月至2005年1月,我院对拟行CABG合并肾动脉狭窄的82例患者的104支狭窄肾动脉行肾动脉支架治疗。82例中合并高血压者77例,肾功能减退者21例。患者在肾动脉支架术前不用抗血小板药物。术后观察患者肾功能的变化。结果104处病变肾动脉支架成功率100%,无并发症。术前肾功能减退者中9例于出院时血肌酐下降,3例支架术后一过性血肌酐升高;术前肾功能正常者中4例支架术后一过性血肌酐升高。所有支架术后一过性血肌酐升高均为双侧肾动脉重度狭窄。结论肾动脉狭窄可能导致CABG术后急性肾功能衰竭的发生。CABG前行肾动脉支架术可能预防术后急性肾功能衰竭的发生。Objective To study the treatment of renal artery stenting for patients with coronary artery heart disease and renal artery stenosis who need coronary atery bypass graft （CABG） and its effect on preventing acute renal dysfunction after CABG. Methods From April 2001 to January 2005, renal artery stenting was carried out in 82 patients （ a total of 104 renal arteries） with CHD and renal artery stenosis who needed CABG. Among the 82 patients, 77 of them accompanied with hypertension and 21 of them had abnormal renal function. Heparin was selected as anticoagulant other than anti-platelet drug and low molecular weight heparin before stenting. Results All of the stents were successfully implanted in 104 renal lesions without complication. Blood creatinine （Cr） reduced in 9 patients with renal dysfunction by the time of discharge. Three patients had blood Cr increased provisionally after stenting. Four patients with normal pre-operational renal function showed transient increase in blood Cr after stenting. All of the patients with transient blood Cr elevation had bilateral renal artery stenosis. Conclusion Renal artery stenosis may cause acute renal failure after CABG. Pre-CABG renal artery stenting may prevent the occurance of acute renal failure after operation.

关 键 词：冠状动脉分流术 肾动脉梗阻 支架 

分 类 号：R541.4[医药卫生—心血管疾病]