重症心脏瓣膜病术后肾功能不全患者连续性肾替代治疗体会  

Experience of continuous renal replacement therapy for postoperative renal insufficiency in patient with severe heart valve disease

作　　者：李谦平[1] 张军[1] 罗卫民[1] 原野[1] 程栋梁[1] 曾敏[1] 

机构地区：[1]湖北医药学院附属太和医院胸心外科,湖北十堰442000

出　　处：《岭南心血管病杂志》2011年第1期30-32,共3页South China Journal of Cardiovascular Diseases

基　　金：2009年湖北省教育厅项目资助(项目编号:D20092402)

摘　　要：目的总结重症心脏瓣膜术后发生肾功能不全患者采用连续性肾替代治疗(continuous renal replacement therapy,CRRT)的经验。方法回顾性分析15例重症风湿性心脏瓣膜病术后合并肾功能不全,术后行床旁CRRT治疗,取得了良好效果的患者的临床资料,着重分析CRRT治疗方法和效果。其中10例为主动脉二尖瓣联合瓣膜病变患者,1例为主动脉瓣膜病变患者,其余为二尖瓣合并三尖瓣瓣膜病变患者。术前心功能评估为纽约心脏协会心功能Ⅲ～Ⅳ级,手术前后监测肾功能和尿量,术后行床旁CRRT的治疗,监测肾功能。结果除1例合并顽固性心力衰竭患者死亡外,其余均治愈,最短5d,最长1个月肾功能恢复。结论重症心脏瓣膜术后肾功能不全患者,尽早行CRRT,效果好,恢复快。Objectives To summarize the experience of continuous renal replacement therapy （CRRT） for postoperative renal insufficiency in patient with severe heart valve disease. Methods We retrespectively analyzed the clinical data of 15 patients with severe rheumatic heart valves diseases who got postoperative renal insufficiency and performed CRRT, focusing on method and effect of CRRT. Ten out of 15 were mitral combined with aortic valve disease,one case was aortic valve disease, the others were the mitral valve combined with tricuspid valve disease. Preoperative assessment of cardiac function were New York Heart Association （NYHA） Ⅲ- Ⅳ stage. Renal function and urine output before and after surgery were detected.CRRT was immediately adopted in the treatment of postoperative renal insufficiency with continuous monitoring of renal function. Results One case was dead of intractable heart failure and the rest were cured. Damaged renal function was recovered after 5 days and the longest time was up to one month. Conclusions The earlier was treated with CRRT, the more effective and rapider recovery were acquired insufficiency after severe heart valve surgery in patient with renal.

关 键 词：心脏瓣膜病 体外循环 连续性肾替代 

分 类 号：R692.5[医药卫生—泌尿科学]