心脏手术与急性肾功能不全  

ACUTE RENAL INSUFFICIENCY FOLLOWING CARDIAC SURGERY

作　　者：邵冲[1] 朱家麟[1] 谢永明[1] 彭勇[1] 倪斌[1] 臧蔚[1] 

机构地区：[1]江苏省苏州市第二人民医院心脏中心,江苏苏州215002

出　　处：《实用临床医药杂志》2003年第2期131-134,共4页Journal of Clinical Medicine in Practice

摘　　要：目的　分析心脏手术后急性肾功能不全的原因 ,提出围手术期的处理要点。方法　对 13 45例心脏手术后发生肾功能不全的 2 82例的临床资料进行分析 ,其中轻度肾功能不全 189例 ,中度 69例 ,重度 14例 ,极重度 10例。结果　总的肾功能不全的发生率 2 0 97% (2 82 /13 45 ) ,总住院死亡率 3 712 % (4 2 /13 45 ) ,2 82例肾功能不全患者住院死亡 2 4例(8 5 1% ) ,术前伴发病、心功能分级、手术种类和心肺转流时间与术后肾功能不全的发生率有显著差异。结论　心脏手术后肾功能不全的发生和轻重程度 ,与术前伴发病、心功能分级、手术种类和心肺转流时间有密切关系。轻度、中度肾功能不全以强心、利尿、扩血管、保护肾功能为主 ,中度和重度肾功能不全者以腹膜透析为主 。Objective: To analyze the causes that result in acute renal insufficiency after cardiac surgery and propose some suggestions in perioperation treatment. Methods: Clinical material of 282 case acute renal dysfunction was discussed after 1 345 cases cardiac surgery. Among them, 189 cases were mild degree dysfunction, 69 cases middle degree were. 14 cases way severity degree had severity degree and 10 cases were extreme severity.Results: The incidence of renal insufficiency was 20 97%(282/1 345). The total mortality was 3 71%(42/1 345). The mortality of 282 patients with acute renal dysfunction after cardiac surgery was 8 55%(24/282). Preoperative companion diseases, cardiac function, surgical type and cardiopulmonary bypass diftered greatly from renal dysfunction after heart operation. Conclusions: The result showed that preoperative companion diseases, cardiac function, surgical type and cardiopulmonary bypass were major factors that induced acute renal dysfunction after heart operation. Mild or middle degree insufficiency was treated mainly by inotropic, diuretic or diastolic vascular therapy. Excessively severe renal dysfunction was dialysed in perioperative treatment.

关 键 词：心脏手术 急性肾功能不全 围术期处理 心功能 

分 类 号：R654.2[医药卫生—外科学] R692.5[医药卫生—临床医学]