维持性血液透析合并瓣膜病患者的外科治疗

Surgical treatment for dialysis-dependent patients associated with valvular disease

目的 总结维持性血液透析合并瓣膜病患者的外科治疗结果.方法 2006年1月至2015年10月,我科室收治维持性血液透析合并瓣膜病患者共46例,男性35例,女性11例,年龄（41±12）岁.患者行常规或微创瓣膜手术,包括瓣膜置换和成形术,合并冠心病者同期行冠状动脉旁路移植术.围术期予常规血液透析和床旁连续性血液透析滤过相结合的方法行肾脏替代治疗.结果 所有患者均顺利完成手术.术后呼吸机平均使用时间（33.1±66.7）h,ICU时间平均（7.3±4.1）d.术后5例患者死亡,死亡率10.7％.术后CRRT时间（55.8±22.9）h,常规血透3-18次.术后随访32例患者,平均随访（26.3±15.6）个月,4例患者死亡.结论 瓣膜手术联合围术期的肾脏代替治疗是对维持性血透合并瓣膜病患者的有效治疗方式.微创手术、早期干预,有望降低该类患者围术期的死亡率.

Objective To summary the results of surgical treatment for dialysis-dependent patients associated with valvular disease.Methods Between January 2006 and October 2015,46 patients （35 males,11 females） received this therapy.The age of these patients were （41±12）years.The standard or minimal invasive procedure was performed for these patients,including valve replacement and repair.Concomitant coronary artery bypass was performed if indicated.The perioperative renal replacement treatment was standard dialysis combined with continuous renal replacement therapy（CRRT）.Results All procedures were performed successfully.Time of ventilation were （33.1 ±66.7）hours.ICU stay were （7.3±4.1）days.5 patients died after procedure.Mortality rate was 10.7%.Duration of CRRT were （55.8±22.9）hours.The frequencies of standard dialysis were 3-18.32 patients were followed up.The follow up duration were （26.3±15.6）month,in which four patients died.Conclusion Valvular procedure and perioperative dialysis are effective for the dialysis dependent patients associated with valvular disease.Minimally invasive surgery,early intervention are expected to reduce perioperative mortality in this patients.