维持性血液透析患者腹部手术的可行性及围术期处理

Feasibility of accepting abdominal surgery and the experience of perioperative management in patients with maintenance hemodialysis

目的探讨维持性血液透析患者伴发腹部外科疾病手术治疗的可行性及围术期处理要点。方法回顾性分析2013年6月~2017年6月六安市第二人民医院维持性血液透析患者因腹部外科疾病手术22例患者的临床资料,对比其手术前后的体质量、血红蛋白、白蛋白、电解质及肾功能的变化,记录有无并发症及总结围术期处理体会。结果 22例患者手术后血红蛋白较手术前降低(P<0.05),手术前后体质量、血液白蛋白、电解质及肾功能等变化比较差异无统计学意义;术中1例出现频发性室性早搏、1例手术野渗血较多,术后1例出现低血压,2例出现切口愈合不良,经针对性处理均恢复良好。结论维持性血液透析患者伴发腹部外科疾病手术风险虽较高,但只要做好完善的围术期管理,患者多可耐受手术,并获得满意的恢复。

Objective To explore the feasibility of accepting abdominal surgery in patients with maintenance hemodialysis(MHD), and to summarize the experience of perioperative treatment of MHD patients. Methods A retrospective analysis was performed in 22 MHD patients with general surgery in Lu'an Second People's Hospital from June 2013 to June 2017. The changes of body weight, hemoglobin, albumin, electrolyte and renal function before and after the operation were compared and analyzed. The complications were recorded and the perioperative treatment experience was summarized. Results In 22 patients, hemoglobin decreased after surgery(P<0.05), and no significant difference was found in body weight, albumin, electrolyte and renal function before and after operation. Five cases showed surgical complications,including 1 cases of frequent ventricular premature beats and 1 cases of more bleeding during operation, 1 cases of postoperative hypotension, 2 cases of poor healing of the incision. These complications were well restored by targeted treatment. Conclusion The risk of general surgery is higher in patients with MHD. However, after a good preoperative management, the patient can tolerate surgery and obtain satisfactory recovery.