术前伴有严重肾功能不全的患者围术期管理经验

Perioperative treatment for cardiac surgical patients with severe renal insufficiency

目的总结术前伴有严重肾功能不全的心脏手术患者围术期管理的临床经验。方法收集2014年6月至2015年9月南京军区南京总医院收治的25例术前伴有严重肾功能不全的心脏手术患者围术期治疗资料。心脏手术后积极进行连续性肾脏替代疗法(CRRT)。结果 CRRT 12 h后患者心率、中心静脉压、肌酐、尿素氮较未透析时明显下降(P<0.05),平均动脉压、动脉血氧分压较上CRRT之前明显升高(P<0.05)。围术期1例患者出现心脏骤停,经过及时有效的CPR成功复苏,1例患者因经济原因放弃治疗,其余23例患者中有6例转至本院肾脏内科规律透析治疗,15例患者肾功能恢复到术前水平,出院后尿量恢复未再透析治疗,术后随访(12.2±1.5)个月,心脏症状均明显改善,生存质量明显提高。结论 CRRT是严重肾功能不全患者心脏围术期治疗的重要方法,肾功能不全患者并非心脏手术的禁忌证。

Objective Perioperative treatment for cardiac surgical patients with severe renal insufficiency. Methods 25 pa- tients with severe renal insufficiency wereadmitted for heart surgery in General Hospital of Nanjing Military Region from June 2014 to September 2015. Continous renal replacement therapy（CRRT） was performed in all patients. Results Two patients died postoperatively. HR, CVP, ereatinine and BUN signifcantly decreased 12 hour after CRRT （ P 〈0.05） ,while MAP and PaO2 significantly increased （ P 〈0.05）.Six of the 23 suvivals received regular dialysis and fifteen stopped dialysis treatment when their renal function returned to preoperative levels and urine volume recovered.Postoperation follow-up period was （12.2±.5 ）months.All patients were asymptomatie and thequality of life remarkably improved.Conclusion CRRT can be an important procedure in the periopeartive treatment forcardiac surgical patients with severe renal insufficiency.