腹膜透析治疗体外循环心脏手术后急性肾功能衰竭  

Peritoneal dialysis for acute renal failure following cardiac surgery with cardiopulmonary bypass

作　　者：赵枫[1] 徐志云[1] 梅举[1] 邹良建[1] 

机构地区：[1]第二军医大学长海医院胸心外科,上海200433

出　　处：《第二军医大学学报》2004年第4期454-455,共2页Academic Journal of Second Military Medical University

摘　　要：目的 :探讨腹膜透析 (PD)对体外循环心脏手术后急性肾功能衰竭 (ARF)的治疗效果及其对术后早期血流动力学的影响。 方法 :回顾 88例体外循环心脏手术后 ARF行 PD治疗患者的临床资料 ,其中 36例术后早期 (术后 3d)内就行 PD治疗 ,另外 5 2例术后 3d后行 PD治疗。分析 PD前后血尿素氮 (BU N)、肌酐 (Cr)、钾离子 (K+ )、碳酸氢根离子 (HCO3- )浓度的变化 ,对其中 36例术后 3d内就行 PD治疗的患者 PD前后的血流动力学进行分析。 结果 :PD后 1 d血 [K+ ]恢复正常 ,1～ 4d内血 [HCO3- ]恢复正常 ,4～ 6 d内 BU N下降 4 9.2 % ,Cr下降 4 2 .6 % (P<0 .0 5 ) ,Cr在 3～ 1 6 d时恢复到术前水平 ,PD治疗后 3～ 39d内肾功能恢复。 36例术后 3d内就行透析的患者 ,平均动脉压 (MAP)和心脏指数 (CI)在 PD后有所上升 ,但与PD前相比无显著差异。 结论 :PD对体外循环心脏手术后 ARF有较好的治疗效果 ,对血流动力学无明显影响 ,是一种安全、有效的治疗措施 ;对心脏术后合并 ARF者 ,应及早进行 PD治疗 ,并且需强调 PD的持续性与充分性 。Objective:To evaluate the therapeutic effectiveness of peritoneal dialysis(PD) for acute renal failure(ARF) following cardiac surgery with cardiopulmonary bypass and its effect on hemodynamics. Methods:Retrospective data from 88 patients with ARF following cardiac surgery undergoing PD were analyzed. Results:The renal function of the patients recovered within 3 to 39 d of PD, K +] declined to normal level within 1 d, HCO 3 -] declined to normal level within 1 4 d, and BUN and Cr declined by 49.2% and 42.6% respectively within 4 6 d of PD( P <0.05).Mean artery pressure(MAP) and cardiac index(CI) of the patients undergoing PD early post operation (within 3 d) did not change significantly during and after PD. Conclusion:PD has a good therapeutic effectiveness for ARF following cardiac surgery with cardiopulmonary bypass without obvious effects on hemodynamics.To improve its therapeutic effectiveness,PD should be performed as soon as ARF is diagnosed and should be lasted for enough time.

关 键 词：腹膜透析 治疗 体外循环 心脏手术 急性肾功能衰竭 

分 类 号：R692.5[医药卫生—泌尿科学]