体外循环心脏术后急性肾衰竭的高危因素分析及救治体会

High-risk factors and treatment experiences of acute renal failure following cardiac surgery with cardiopulmonary bypass.

目的探讨体外循环(CPB)心脏手术后急性肾衰竭(ARF)的原因及防治方法。方法对6例CPB心脏手术后ARF患者进行回顾性分析及文献复习。结果6例中有5例死亡,病死率为83.3%。2例未来得及透析治疗即死亡;3例血液透析者均死亡,1例经腹膜透析治疗,肾功能恢复正常,治愈出院。结论CPB心脏手术后发生ARF与CPB时间长、术前肾功能不全、术前心功能差、老年及使用肾毒性药物等因素有关,围术期对上述高危因素需充分重视;术后一旦发生ARF宜及早行肾脏替代治疗。

Objective To investigate the reasons,the prevention and treatment measures of acute renal failure（ARF） following cardiac surgery with cardiopulmonary bypass（CPB）.Methods Retrospective analysis of 6 patients with ARF following cardiac surgery was made and the relative literature was reviewed.Results There were 5 deaths of 6 patients including 2 patients without enough time to dialysis treatment and 3 patients with hemodialysis.The hospital mortality rate was 83.3%.1 patient with peritoneal dialysis was discharged uneventfully from hospital and its renal function was recovery.Conclusion ARF following cardiac surgery with CPB was related to long CPB time,preoperative renal insufficiency,preoperative bad cardiac function,the elderly and the use of renal toxicity drugs.Full attention should be paid to those high-risk factors in perioperative period.Once ARF happened postoperatively,renal replacement therapy should be applied as soon as possible.