慢性肾功能不全病人行体外循环心脏直视手术围术期处理

Open Heart Surgery in Patients with Chronic Renal Disease

目的：探讨慢性肾功能不全病人行体外循环心内直视手术的危险性。方法：１９９３年３月到１９９７年６月间对术前诊断为氮质血症期１８例、肾功能不全代偿期４例、尿毒症期１例共２３例病人，在心脏手术围术期均给予积极治疗。结果：术后早期肾功能指标较术前差，围术期经腹透４例，血透１例治疗后，肾功能指标有所改善。２０例康复出院，３例死亡。结论：术前肾功能不全病人绝大多数可以安全地渡过肾功能衰竭关，达到改善症状及提高生活质量的目的。

Aim:To evaluate the effect of open heart surgery on patients with chronic renal disease.Clinical material and method:23 patients with chronic renal disease underwent open heart surgery under cardiopulmonary bypass(CPB).Before surgery,4 patients were in compensatory stage of renal failure,18 patients were azotenesic and one uremic.Surgical procedures included mitral valve replacement in 7,aortic valve replecement in 5,double valve replacement in 8.Bentall procedure in 2 and excision of left atrial myxoma in 1.The mean CPB time was 118 minutes and the mean arotic clamping time was 76 minutes.Result:The results demonstrated that all indexes of renal function in early stage of postoperation were worse than those of preoperation.The renal function was greatly improved after proper treatment(4 patients with peritoneal dialysis,1 patient with hemodialysis).20 patients were discharged from hospital except 3 deaths with a hospital mortality rate of 13%.Conclusion:It is suggested that the majority of patients with renal insufficiency can tolerate cardiac surgery and recover with proper treatment.