摘要
目的比较接受心脏移植(heart transplantation,HT)和左心室辅助装置(left ventricular assist device,LVAD)植入患者的围术期肾功能变化。方法纳入2019年1月—2024年4月于首都医科大学附属北京安贞医院行手术治疗的终末期心力衰竭患者。根据手术方式,将患者分为HT组和LVAD组,比较两组患者术前、术后第1、7、30、60天时的肾小球滤过率(estimated glomerular filtration rate,eGFR),并对术前即存在肾功能不全的患者进行亚组分析,比较两组患者术前和术后30 d时的eGFR变化。结果共纳入112例患者,其中HT组78例,男61例、女17例,平均年龄(44.42±18.51)岁;LVAD组34例,男30例、女4例,平均年龄(54.94±11.37)岁。与HT组比较,LVAD组患者的平均年龄更大(P<0.001),体重指数更高(P=0.008),术前eGFR更低(P=0.009),吸烟(P=0.017)、饮酒(P=0.041)以及糖尿病(P=0.028)患者占比更高。在术前肾功能不全[eGFR<90 mL/(min·1.73 m^(2))]患者中,与HT组比较,LVAD组术后30 d eGFR显著更高(P=0.001),且较术前显著升高;HT组术后30 d eGFR与术前相当,超过一半的患者eGFR较术前更低。在术前肾功能不全患者中,HT组11例患者接受连续性肾脏替代治疗,8例早期死亡;LVAD组2例患者接受连续性肾脏替代治疗,1例早期死亡。结论对于合并肾功能不全的终末期心力衰竭患者,与HT比较,LVAD植入患者肾功能获益更多。
Objective To compare the perioperative renal function changes in patients undergoing heart transplantation(HT)and left ventricular assist device(LVAD)implantation.Methods Patients with end-stage heart failure who underwent surgical treatment at Beijing Anzhen Hospital,Capital Medical University from January 2019 to April 2024 were included.According to the surgical method,patients were divided into a HT group and a LVAD group,and the estimated glomerular filtration rate(eGFR)of patients before surgery and postoperative 1,7,30,60 days was compared between the two groups.The patients with preoperative renal dysfunction were subdivided into subgroups for comparison of eGFR changes before surgery and 30 days after surgery between the two groups.Results A total of 112 patients were enrolled.There were 78 patients in the HT group,including 61 males and 17 females,aged(44.42±18.51)years.There were 34 patients in the LVAD group,including 30 males and 4 females,aged(54.94±11.37)years.Compared with the HT group,the average age of patients in the LVAD group was greater(P<0.001),body mass index was higher(P=0.008),preoperative eGFR was lower(P=0.009),and the proportions of smokers(P=0.017),alcohol drinkers(P=0.041),and diabetes mellitus(P=0.028)patients were higher.Among patients with preoperative renal dysfunction[eGFR<90 mL/(min·1.73 m^(2))],compared with the HT group,the postoperative eGFR of the LVAD group was significantly higher than that of the HT group,and it was significantly increased compared with that before surgery;the postoperative eGFR of the HT group was comparable to that before surgery,and more than half of the patients had a lower eGFR than before surgery.Among patients with preoperative renal dysfunction,11 patients in the HT group received continuous renal replacement therapy,and 8 died early;2 patients in the LVAD group received continuous renal replacement therapy,and 1 died early.Conclusion For end-stage heart failure patients with combined renal dysfunction,compared with HT,LVAD implantation enables patients to obtain better renal function benefits.
作者
温明修
赵双雷
刘周
胡熠
李前贤
韩杰
张宏家
贡鸣
WEN Mingxiu;ZHAO Shuanglei;LIU Zhou;HU Yi;LI Qianxian;HAN Jie;ZHANG Hongjia;GONG Ming(Department of Cardiac Surgery,Beijing Anzhen Hospital,Capital Medical University,Beijing,100029,P.R.China)
出处
《中国胸心血管外科临床杂志》
CSCD
北大核心
2024年第11期1594-1598,共5页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
基金
国家重点研发计划(2021YFC2501100)
国家自然科学基金(82370399)
首都卫生发展科研专项项目(首发2022-2-1053)。
关键词
左心室辅助装置
心脏移植
肾功能
终末期心力衰竭
Left ventricular assist device
heart transplantation
renal function
end-stage heart failure