肾功能不全患者瓣膜置换术后近期疗效与围手术期处理  

Perioperative management and impact of preoperative renal dysfunction on short-term survival for patients undergo- ing valve replacement

作　　者：刘健[1] 叶一舟[1] 虞敏[1] 施盛[1] 袁忠祥[1] 

机构地区：[1]上海交通大学附属第一人民医院心血管外科,200080

出　　处：《中华胸心血管外科杂志》2013年第4期200-203,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的分析合并肾功能不全患者瓣膜置换术后处理及疗效分析。方法单纯瓣膜置换术患者536例，按术前内生肌酐清除率（GFR）分为肾功能正常组（GFR〉70ml·min-1·1．73m2）322例，轻度肾功能不全组（GFR50—70ml·min-1·1．73m12）162例，中度肾功能不全组（GFR30～50ml·min-1·1．73m12）40例，重度肾功能不全组（GFR〈30ml·min-1·1．73m-2）12例。多因素回归分析患者术前肾功能不全程度与术后死亡及各种并发症的关系。结果患者术前肾功能分级与术前肾功能不全程度、年龄、高血压、左心室扩大、左心室射血分数有关，差异有统计学意义。术后病死率随肾功能不全程度加重而上升。术后大量输血，再次气管插管，机械通气时间延长，ICU监护时间延长，住院时间延长的发生率均随肾功能不全程度加重而上升。结论术前肾功能不全是瓣膜置换术后死亡和并发症发生的重要预测因子，应加强围手术期管理。Objective To review the experience of perioperative management and effect of valve replacement combined with renal dysfunction. Methods 536 cases of valve replacement. According to preoperative glomerular filtration rate（ GFR）, renal dysfunction was classified as normal in 322 cases, mild in 162, moderate in 40 and severe in 12. Logistic regression anal- ysis was used to assess the effect of preoperative renal dysfunction on operative mortality and morbidity. Results Patients with a lower GFR were older and more likely to have hypertention. They also tended to have larger left ventrieular end-diastolic di- ameter and worse left ventricular ejection factor. Operative mortality rose inversely with declining renal function, from 2% for those with normal renal function to 17% for patients with severe renal dysfunction. Renal dysfunction was significantly associat- ed with a large blood transfusions, re-intubation, longer mechanical ventilation, intensive care unit stay and hospital stay. Conclusion Preoperative renal dysfunction is an important factor of postoperative mortality and morbidity for valve replace- ment. We must pay more attention to perioperative management.

关 键 词：心脏瓣膜 人工 肾功能不全 围手术期医护 

分 类 号：R65[医药卫生—外科学]