维持性血液透析患者行冠状动脉搭桥术的临床分析

Coronary artery bypass in patients with end-stage hemodialysis-dependent renal failure

目的通过分析2例尿毒症维持性血液透析(HD)患者冠状动脉搭桥术(CABG)围手术期资料,探讨维持性血液透析患者行CABG的安全性。方法回顾性分析2例尿毒症维持性血液透析患者行冠状动脉搭桥术的临床资料。结果手术前一天均给予无肝素透析,术后均行持续床旁血液滤过透析(CHDF)。1例患者经完善的围手术期处理,手术成功,患者存活,生活质量明显改善;1例患者术后第3天于血液透析后死于心包填塞。结论维持性血液透析患者经过积极、周密的术前准备,术中及术后处理,可以接受冠状动脉搭桥术,可达到改善症状、提高生活质量、延长生命的目的。CHDF是慢性肾功能衰竭患者围手术期有效维持水、电解质平衡的透析方式。

Objective To evaluate the safety of coronary artery bypass grafting(CABG) on patients with end-stage hemodialysis-dependent renal failure.Method Two patients with hemodialysis who received CABG were reported.The features of clinical manifestation were studied.Results CHDF was preformed in two cases after operation.One patient died of hemorrhage on the third day after operation,the other patient showed relief of recurrent chest pain and improved quality of life after CABG.Conclusion Under a well-prepared dialysis program and meticulous perioperative management,CABG can be performed in dialysis-dependent patients,with increased but acceptable perioperative morbidity and mortality risks.Our initial experiences of CHDF during and after CABG suggest that the technique provides excellent electrolyte,metabolite and fluid management for the cardiac patients with chronic renal failure.