肾功能不全者心脏手术后的疗效分析

Management of Renal Insufficiency in Patients Undergoing Cardiac Surgery SHAO Chong*,ZHU Jialin,ZHANG Baoren,et al.Department of Cardiothora

目的：分析合并肾功能不全心脏病人行体外循环心内直视手术的疗效。方法：４３例术前心功能（ＮＹＨＡ）ＩＩ级７例、ＩＩ级１８例、ＩＶ级１８例病人，行先天性心脏病手术５例、瓣膜替换术３６例、冠状动脉搭桥术２例。术前肾功能不全为轻度者３４例、中度５例、重度４例。结果：术后肾功能正常１８例、轻度不全４例、中度７例、重度１４例。并发症发生率５３．４８％，住院病死率１８．６０％。结论：只要围术期处理恰当，肾功能不全病人心脏手术效果是满意的；术后肾功能不全对早期疗效影响大。

Aim:To review the experience of perioperative management of renal insufficiency in patients undergoing open heart surgery.Clinical material and method:Fortythree patients with renal insufficiency underwent open heart surgery from 1990 to 1994.There were 30 men and 13 women with a mean age of 45 years.Preoperative heart function(NYHA) was class II in 7 patients,class III in 18 and class IV in 18.According to creatine and BUN level,renal failure was classified as mild in 34 cases,moderate in 5 and severe in 4.Surgical procedures performed included correction of congenital heart diseases in 5,valve replacement in 36 and coronary artery bypass grafting in 2.Before operation,2 patients received hemodialysis for severe renal failure.After surgery,14 patients received peritoneal dialysis and 5 had hemodialysis.Results:The operative mortality was 18.6%(8/43).The main causes of deaths were multiple organ failure(87.5%) and arrhythmia(12.5%).The morbidity rate was 53.5%.Normal renal function was found in 18 patients postoperatively.4 cases had mild renal insufficiency,7 moderate and 14 severe.The incidence of complications in those patients was 27.8%,50%,85.7% and 71.4%,respectively.Conclusion:Operative mortality and morbidity are closely related to the degree of postoperative renal insufficiency.Proper management during perioperative period would improve surgical outcome.