先天性心脏病体外循环术后透析治疗临床研究——附41例临床分析  

The clinical analysis of dialysis therapy after cardiopulmonary bypass surgery of congenital heart disease—41cases reports

作　　者：肖燕燕[1,2] 金梅[1,2] 韩玲[1,2] 

机构地区：[1]首都医科大学附属北京安贞医院 [2]北京市心肺血管疾病研究所心儿科,北京100029

出　　处：《心肺血管病杂志》2011年第4期273-276,共4页Journal of Cardiovascular and Pulmonary Diseases

基　　金：首都医学发展科研基金(项目任务书编号2009-3112)

摘　　要：目的:总结和分析先天性心脏病(先心病)体外循环术后透析治疗患者的临床特点,探讨临床相关危险因素。方法:以2006年1月至2009年12月于我科行先心病体外循环手术,并于术后行透析治疗的41例患者为研究对象,回顾性分析其临床资料并总结其临床特点。结果:1.体外循环手术各病种透析发生率,由高至低依次为左冠状动脉起源于肺动脉、完全性大动脉转位及右心室双出口、法洛四联症7.62%、完全型房室隔缺损、主动脉弓缩窄/离断、单心室、完全性肺静脉异位回流及室间隔缺损。2.透析患者中存活23例(23/41,56.1%),存活患者尿量及肾功能均恢复正常。死亡18例(18/41,43.9%)。死亡患者中以完全型房、室间隔缺损、法洛四联症最常见。3.透析患者体外循环时间95～395 min,平均185 min,心肌阻断时间82～188 min,平均132 min。4.透析患者手术风险分布:1级1例,2级24例,3级14例,4级5例。5.出现少尿与透析开始时间相距(1～9)h,平均5 h,透析持续时间10～1 008 h,平均75 h,透析效果满意。6.41例透析患者全部合并诊断低心排出量综合征(低心排),18例死亡患者中5例诊断多器官功能障碍综合征。结论:低年龄、长时间体外循环及心肌阻断时间、畸形矫治不彻底、术后低心排是透析治疗的有关危险因素,正确掌握透析适应证及时机是治疗关键。Objective：To evaluate the clinical characteristic of the patients who accepted peritoneal dialysis after cardiac surgery and explore the clinical risk factors.Methods：The patients who underwent cardio-pulmonary bypass surgery and postoperative dialysis from January 2006 to December 2009 were enrolled in this study,retrospective summarize and analysis the clinical characteristics.Results：1.The incidence of dialysis from high to low were ALCAPA,cTGA,DORV,TOF 7.62%,TECD,CoA/IAA,SV,TAPVC and VSD.2.23 cases survived and recoverd（23/41,56.1%）,18 cases（18/41,43.9%） died.The mortality were higher in the TECD and TOF cases.3.Cardiopulmonary bypass time 95~395 min（media 185） min and cardiac occlusion time 82-188 min（media 132） min.4.RACHS-1 categories were from 1 to 4,category1∶1 case;category 2∶24 cases;category 3∶14 cases;category 4∶5cases.5.Duration between oliguric and dialysis start time were1-9 h（media 5 h）,dialysis duration were 10-1 008 hours（media 75h）,all patients with dialysis got satisfactory results,according to clinical demands and revealed a surplus body fluids.6.All of the 41 dialysis patients were combined diagnosis of low cardiac output syndrome,18 patients died,5 were diagnosed with multiple organ dysfunction syndrome.Conclusion：Younger age,long CPB and myocardial clamp time,deformity correction not complete,low cardiac output post operation were related risk factors of acute renal failure and dialysis.

关 键 词：先天性心脏病 体外循环 透析 

分 类 号：R541.1[医药卫生—心血管疾病]