心脏手术后机械辅助循环患者急性肾衰竭的临床分析  

Treatment of acute renal failure in critical ill patients supported by circulatory assist devices after open heart surgery

作　　者：贾明[1] 邵涓涓[1] 周啸[1] 黄方炯[2] 孟旭[2] 顾承雄[2] 张健群[2] 贾士杰[1] 

机构地区：[1]首都医科大学附属北京安贞医院心脏外科监护室,100029 [2]首都医科大学附属北京安贞医院心脏外科,100029

出　　处：《北京医学》2007年第12期720-722,共3页Beijing Medical Journal

摘　　要：目的探讨心脏手术后进行机械辅助循环的患者发生急性肾衰竭(ARF)的治疗方法及效果。方法回顾分析我院心脏外科监护病房(ICU)收治的246例心脏手术后进行机械辅助循环患者的临床资料。结果56例发生ARF,其中27例接受连续性血液净化治疗(CBP),CBP模式为连续静脉-静脉血液透析滤过(CVVHDF)。56例ARF患者中死亡23例,其中27例进行CBP治疗的患者死亡15例(55.6%)。主要相关并发症有出血、感染、血小板减少、低血压等。结论辅助循环患者发生ARF与低血压、血容量不足以及大剂量缩血管药物的应用等因素有关。CBP可以在一定程度上改善患者循环状况,但预后有赖于基础疾病的严重程度。Objective To investigate the treatment of acute renal failure （ARF） in critical ill patients supported by circulatory assist devices after open heart surgery. Methods From January 2005 to February 2007, 246 patients had circulatory support for postcardiotomy cardiorespiratory function failure in postcardiac surgical intensive care unit. Left ventricular assist device （LVAD） was used in 3 patients and intra-aortic balloon pumping （IABP） in 195 patients for postcardiotomy cardiac function failure. Extracorporeal membrane oxygenation （ECMO） was initiated in 48 patients for postoperative cardiorespiratory function failure. Results ARF occurred in 22.8% of cases （56 of 246 patients） during circulatory assist. Twenty-seven patients treated with continuous blood purification （CBP）. The treatment model was continous venovenous hemodialfiltration（CVVHDF）. The mortality rate in the ARF group was 41.1% （23 of 56patients）. And 15（55.6%） cases died in CBP group. The most common complications were bleeding, infection, thrombocytopenia and hypotension. Conclu- sions Acute renal failure following circulatory support is closely associated with postcardiotomy hypotension, hypovolemia and usage of high dose vaso-contractors. CBP is an effective way for treating ARF. But the overall prognosis depends on the primary heart disease.

关 键 词：机械辅助循环 急性肾衰竭 连续性血液净化 

分 类 号：R654.2[医药卫生—外科学]