肾功能不全老年患者心脏手术体外循环管理

Management of extracorporeal circulation during cardiac surgery in elderly patients with renal dysfunction

目的:总结轻-中度肾功能不全老年患者心脏手术体外循环的管理方法及临床经验。方法:回顾性分析于2011-03-2012-09在我院进行心脏手术的肾功能不全且年龄>60岁的患者资料26例,对心脏手术前后的血清肌酐及尿素氮水平进行比较。结果:无死亡病例。术前尿素氮及血清肌酐分别为(11.4±2.3)mmol/L和(153.7±11.1)μmol/L,术后48h分别降至(7.5±1.1)mmol/L和(89.6±21.3)μmol/L,两指标手术前后均差异有统计学意义(均P<0.05);术后1周血清肌酐及尿素氮与术前相比无明显变化。结论:术前轻-中度肾功能不全、全身状况尚好的老年患者行心脏手术时,采取针对性的的体外循环策略,特别是术中保持较高的体外循环灌注压,避免过度血液稀释,尽量缩短体外循环时间,应用大量零平衡超滤,术后48h尿素氮与肌酐均有所下降,能顺利渡过手术,提高手术成功率,避免相关并发症。

Objective：To investigate the management of extracorporeal circulation （ECC）in elderly patients with renal dysfunction during cardiac surgery.Method：Retrospectively analysis was made in the clinical data of 26 elderly patients with renal dysfunction,who underwent cardiac surgery from March 2011to September 2012.The levels of BUN and creatinine were examined before and after operation.Result：There was no death in this study. Compared with preoperative,the levels of BUN and creatinine decreased after 48hours of operation （all P 0.05）,but there was no difference after one week.Conclusion：Elderly patients with mild renal dysfunction can got cardiac surgery with ECC and avoid relative complications,when appropriate ECC management be used,such as higher perfusion pressures,higher hematocrit,zero-balanced ultrafiltration and shorter ECC period.