心脏移植术后早期肾脏替代治疗的疗效分析  

Early stage renal replacement therapy after heart transplantation and its short-term prognosis

作　　者：刘俊铎[1] 王允彦 姜亦瑶 柴军武[2] 孔祥荣[2] Liu Junduo;Wang Yunyan;Jiang Yiyao;Chai Junwu;Kong Xiangrong(The Department of Nephrology,The First Central Hospital of Tianjin,Tianjin 300192,China;The Department of Cardiac Surgery,The First Central Hospital of Tianjin,Tianjin 300192,China)

机构地区：[1]天津市第一中心医院肾内科,天津300192 [2]天津市第一中心医院心外科,天津300192

出　　处：《实用器官移植电子杂志》2019年第6期472-475,共4页Practical Journal of Organ Transplantation(Electronic Version)

基　　金：国家国际科技合作专项项目（2015DFG31850)

摘　　要：目的分析心脏移植术后因急性肾损伤接受肾脏替代治疗的风险因素,及其对术后短期预后的影响。方法回顾性分析2013年1月—2019年6月单中心接受心脏移植术后早期因急性肾衰接受肾脏替代治疗患者(RT组,15例)与非肾脏替代治疗组患者(NRT组,62例)在年龄、体重指数、术前肾功能及手术方式、体外循环时间、主动脉阻断时间、术中输注红细胞量、输注血浆量等方面的差异,以及两组患者术后28 d内预后的差别。结果RT组患者年龄显著大于NRT组〔(58.70±7.70)岁比(52.80±12.70)岁,P=0.028〕,术前估算肾小球滤过率显著低于NRT组〔(61.00±22.86)ml/min比(75.34±25.16)ml/min,P=0.048〕。RT组患者有2例接受心脏移植+主动脉内球囊反搏术,NRT组1例为心肾联合移植,其余均为单纯心脏移植,RT组患者术中输注血浆量多于NRT组〔(1423.33±572.44)ml比(1053.71±560.77)ml,P=0.024〕。RT组患者术后28 d内病死率显著高于NRT组(53.33%比8.06%,P<0.001)。结论心脏移植术后早期因严重肾损伤而接受肾脏替代治疗是常见而严重的并发症,与患者年龄、术前肾功能受损、术中大量输注血浆等因素相关,是导致术后早期患者死亡的主要危险因素。Objective To investigate the risk factors of early stage renal replacement therapy for acute kidney injury after heart transplantation and its effect on short-term prognosis.Methods We retrospectively studied 77 consecutive heart transplant recipients from January 2013 to June 2019,15 patients of them accepted renal replacement treatment for acute kidney injury at early stage(RT group),and the other 62 patients didn`t(NRT group).The age,BMI,protopathy,renal function before operation,operation model,duration of cardiopulmonary bypass,aortic crossclamp time,volume of blood transfusion and fresh frozen plasma transfusion were compared between the two groups,and the 28 d mortality were analyzed.Results The patients of RT group were older than that of NRT group〔(58.70±7.70)years vs(52.80±12.70)years,P=0.028〕.The estimated glomerular filtration rate(eGFR)before operation were much lower in RT group〔(61.00±22.86)ml/min vs(75.34±25.16)ml/min,P=0.048〕.And more fresh frozen plasma were transfused to patients of RT group〔(1423.33±572.44)ml vs(1053.71±560.77)ml,P=0.024〕.Besides,most patients accepted heart transplantation,two patients in RT group accepted intra-aortic balloon pulsation simultaneously and 1 patients in NRT group accepted combined cardiopulmonary transplantation.Patients with renal replacement therapy had a greater 28 d mortality(53.33%vs 8.06%,P<0.001).Conclusion The early stage renal replacement therapy after heart transplantation is a frequent complication associated with a high short-term mortality and is mainly associated with older age,preoperative renal function impairment and more fresh frozen plasma transfusion during operation.

关 键 词：心脏移植 早期 肾脏替代治疗 短期预后 

分 类 号：R47[医药卫生—护理学]