血液透析降低严重肾功能不全患者心脏外科手术后30天死亡率  

Pre-operativemaintenance hemodialysis reduced the 30-day mortality of severe renal dysfunction patients after cardiac surgery

作　　者：王国勤[1] 谢晓东 程虹[1] 董然[2] 卞维静[1] 叶楠[1] WANG Guo-qin;XIE Xiao-dong;CHENG Hong;DONG Ran;BIAN Weijing;YE Nan(Department of Nephrology,Beijing Anzhen Hospital,Capital Medical University,Beijing 10029,China;Department of Cardiovascular Surgery,Beijing Anzhen Hospital,Capital Medical University,Beijing 10029,China)

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

出　　处：《中国血液净化》2021年第7期449-454,共6页Chinese Journal of Blood Purification

基　　金：首都卫生发展科研专项(2011-2006-07/2018-2-1051);北京市医管局“培育”项目(PX2019022)。

摘　　要：目的探讨严重肾功能不全患者手术前规律血液透析与心脏外科手术后30天内死亡的关系。方法收集2010年1月~2020年10月在北京安贞医院接受心脏外科手术且术前估算肾小球滤过率(eGFR)<30ml/(min·1.73m^(2))患者的围手术期临床资料,分析手术前规律血液透析对手术后30天内死亡率的影响。结果共272例患者纳入研究,男性73.2%,平均年龄(61.4±9.5)岁,手术前进行规律透析的患者85名(31.3%),手术后30天总体死亡率为16.9%。COX回归分析显示手术前进入维持性血液透析治疗(maintenance hemodialysis,MHD)(HR:0.399,95%CI:0.160~0.996,P=0.049)降低患者手术后30天的死亡风险。手术后实施二次开胸手术(HR:4.287,95%CI:1.717~10.705,P=0.002)、手术后左心室射血分数(left ventricular ejection fraction,LVEF)<40%(HR:3.251,95%CI:1.581~6.685,P=0.001)、手术中出血量大(HR:1.133,95%CI:1.033~1.242,P=0.008)及手术后呼吸机使用时间长(HR:1.457,95%CI:1.230~0.909,P=0.024)是严重肾功能不全患者手术后30天死亡风险增加的影响因素;男性患者(HR:0.457,95%CI:0.230~0.909,P=0.024)死亡风险低。结论严重肾功能不全患者接受心脏外科手术的早期死亡风险较高,手术前进行充分的MHD可以降低手术后30天死亡风险。Objectives Patients with severe renal dysfunction undergoing cardiac surgery still are associated with many complications and higher mortality.The present study aimed to investigate the relationship between prEoperative maintenance hemodialysis(MHD)and 30-day mortality after cardiac surgery in patients with estimated glomerular filtration rate(eGFR)<30ml/min/1.73m^(2).Methods A total of 272 severe renal dysfunction patients undergoing cardiac surgery during the period between Jan.2010 and Oct.2020 were retrospectively studied.Multivariate COX proportional hazard was used to estimate hazard ratio(HR)and 95%confidence interval(CI)of the risk for 30-day mortality after the surgery.Results In the 272 severe renal dysfunction patients undergoing cardiac surgery,73.2%were male,the average age was 61.4±9.5years,85 patients(31.3%)had regular MHD before the surgery,and their 30-days mortality after the surgery was 16.9%.COX regression analyses showed that prEoperative MHD reduced the 30-day mortality(HR=0.399,95%CI 0.160~0.996,P=0.049),and that rEoperation(HR=4.287,95%CI 1.717~10.705,P=0.002),lower post-operative left ventricular ejection fraction(LVEF<40%)(HR=3.251,95%CI 1.581~6.685,P=0.001),more intraoperative blood loss(HR=1.133,95%CI 1.033~1.242,P=0.008),and longer post-operative ventilator time(HR=1.457,95%CI 1.230~0.909,P=0.024)were the risk factors for higher 30-day mortality,but male patients(HR=0.457,95%CI 0.230~0.909,P=0.024)had a lower risk of mortality.Conclusions Patients with severe renal dysfunction undergoing cardiac surgery were associated with many complications and higher mortality.PrEoperative MHD before cardiac surgery reduced the 30-day mortality.

关 键 词：维持性血液透析 严重肾功能不全 心脏外科手术 手术后30天死亡率 

分 类 号：R459.5[医药卫生—治疗学]