腹膜透析治疗成人心脏手术后急性肾功能衰竭(附125例报告)

Peritoneal dialysis for acute renal failure following cardiac surgery in adults:a report of 125 cases

目的评价成人心脏外科手术后急性肾功能衰竭腹膜透析治疗的效果。方法回顾性分析1997年1月-2007年11月125例成人心脏外科手术后急性肾功能衰竭行腹膜透析治疗患者的临床资料,分析透析前后血尿素氮、肌酐、钾离子和白蛋白的变化。结果共行心脏手术8451例,术后出现肾功能衰竭358例,发生率为4·4%,其中行腹膜透析治疗者125例,占手术总数的1·5%。117例患者腹膜透析后1d钾离子恢复正常,透析后3d尿素氮(10·5±3·6mmol/L)、肌酐(129·3±41·6μmol/L)较透析前明显下降(P<0·05)。透析时间为5～30d(13·8±7·2d),68例存活,肾功能1周内明显改善者13例,2周内改善者33例;8例由于透析后效果不佳,肌酐或血钾呈进行性上升,行持续肾替代治疗,其中3例在2～5周后肾功能恢复;2例在透析期间发生严重的低蛋白血症。57例死亡,死亡率为45·6%,其中31例死于多脏器功能衰竭(MOF)。引起MOF的主要原因是持续低心排后贯序发生呼衰、肝衰甚至DIC等。结论腹膜透析是治疗成人心脏手术后急性肾功能衰竭的有效方法,尤其适用于存在术后低心排危险的患者,且宜尽早进行。

Objective To evaluate the therapeutic efficacy of peritoneal dialysis（PD） for acute renal failure（ARF） subsequent to cardiac surgical procedures in adults.Method Clinical data of 125 consecutive adult patients,admitted from Feb.1997 to Nov.2007,with ARF subsequent to cardiac surgery and undergone PD,were analyzed retrospectively.The levels of creatinine（Cr）,blood urea nitrogen（BUN）,albumin and kalium ion（[K＋]） were compared before and after PD.Results Of 8451 consecutive adult patients undergone operations on heart,358 cases（4.2%） experienced ARF,and 125 cases（1.5%） required PD.In 117 patients performed PD,[K＋] declined to normal level within one day,BUN and Cr were 10.5±3.6mmol/L and 129.3±41.6μmol/L at the third day after PD respectively,significantly lower than those before PD（P〈0.05）.Within 5-30 days duration（13.8±7.2d） of PD,68 cases survived,the renal function of 13 cases ameliorated within one week,and of 33 cases improved within 2 weeks.8 patients were accepted sustained renal replacement treatment for unsatisfactory effect of PD,and among them 3 patients＇ renal function improved within 2-5 weeks.Hypoproteinemia occurred in 2 patients during PD.For the 125 patients undergone PD,57 cases died,the mortality was 45.6%,among them 33 cases die of subsequent multiple organs failure（MOF）.The major motivation of MOF was continued low cardiac output syndrome which led to respiratory insufficiency,liver function failure and disseminated intravascular coagulation（DIC）.Conclusion Peritoneal dialysis is an effective method for acute renal failure subsequent to cardiac surgery in adult patients,especially applicable to the patients with the risk of low cardiac output syndrome,and it should be performed as early as possible.