血液或腹膜透析患者行體外循環心臟大血管手術的中期結果分析_《中國胸心血管外科臨床雜志》

作者：

劉興榮 , 苗齊 , 張恒 , 張超紀 , 馬國濤 , 曹麗華

中國醫學科學院北京協和醫學院　北京協和醫院　心臟外科，北京　100730;

關鍵詞：

血液透析　腹膜透析　心臟　大血管　外科手術　體外循環

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目的　總結血液或腹膜透析患者行心血管手術的臨床經驗，評價其安全性和有效性。　方法　回顧性分析2004年12月至2011年4月北京協和醫院連續10例維持性血液或腹膜透析患者行心血管手術治療的臨床資料，其中男6例，女4例；年齡23～71 （57.6±13.2）歲。腎功能衰竭的原因為糖尿病腎病6例，慢性腎小球腎炎3例，系統性紅斑狼瘡腎病1例。術前透析時間3～98 （25.2±30.6）個月；血液透析8例，腹膜透析2例。行冠狀動脈旁路移植術5例，Bentall手術1例，主動脈瓣置換術2例，二尖瓣置換術1例，上腔靜脈取栓＋補片加寬成形術1例。擇期手術前1 d均透析1次，術中體外循環期間持續超濾。距手術5～32 h后開始行床旁持續無肝素血液濾過透析，4～7 d后轉為常規血液或腹膜透析。　結果　所有患者手術均順利完成，體外循環時間（125.8±33.5） min，主動脈阻斷時間（77.2±25.5） min。住院期間因胸部切口感染致感染性休克死亡1例。1例術后發生心臟壓塞，緊急二次開胸止血；3例發生心房顫動，給予胺碘酮治療后轉復為竇性心律。隨訪9例，隨訪時間8～76個月，隨訪期間因顱內出血和肝癌死亡2例；7例生存患者心功能均為Ⅱ級，未發生心絞痛、心肌梗死或人工瓣膜異常等心血管相關不良事件。1例腹膜透析患者于出院后14個月因腹膜炎轉為血液透析。　結論　維持性血液或腹膜透析患者經過正確的圍術期處理，可以接受心臟大血管手術，從而改善臨床癥狀、提高生活質量。

引用本文： 劉興榮,苗齊,張恒,張超紀,馬國濤,曹麗華. 血液或腹膜透析患者行體外循環心臟大血管手術的中期結果分析. 中國胸心血管外科臨床雜志, 2012, 19(5): 524-528. doi: 復制

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18.	Kamalakannan D, Pai RM, Johnson LB, et al. Epidemiology and clinical outcomes of infective endocarditis in hemodialysis patients. Ann Thorac Surg, 2007, 83 （6）：2081-2086.
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25.	Mehrotra R, Chiu YW, Kalantar-Zadeh K, et al. Similar outcomes with hemodialysis and peritoneal dialysis in patients with end-stage renal disease. Arch Intern Med， 2011， 171 （2）：110-118.
26.	-88.

1. 　Drey N, Roderick P, Mullee M, et al. A population-based study of the incidence and outcomes of diagnosed chronic kidney disease. Am J Kidney Dis, 2003, 42 （4）：677-684.
2. 　Castledine C, Steenkamp R, Feest T, et al. UK Renal Registry 13 th Annual Report （December 2010）：Chapter 6：survival and causes of death of UK adult patients on renal replacement therapy in 2009：national and centre-specific analyses. Nephron Clin Pract, 2011, 119（Suppl 2）：s107-s134.
3. 　Hwang SJ, Lin MY, Chen HC, et al. Increased risk of mortality in the elderly population with late-stage chronic kidney disease：a cohort study in Taiwan. Nephrol Dial Transplant, 2008, 23 （10）：3192-3198.
4. 　Tomson C, Udayaraj U, Gilg J, et al. Comorbidities in UK patients at the start of renal replacement therapy （chapter 6）. Nephrol Dial Transplant, 2007, 22 （Suppl 7）：vii58- vii 68.
5. 　Sarnak MJ, Levey AS, Schoolwerth AC, et al. Kidney disease as a risk factor for development of cardiovascular disease：a statement from the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention. Hypertension, 2003, 42 （5）：1050-1065.
6. 　Go AS, Chertow GM, Fan D, Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med, 2004, 351 （13）：1296-1305.
7. 　Jayasekera H, Pinto N, Mundy J, et al. Cardiac surgery in the presence of dialysis：effect on mid-term outcomes and quality of Life. Heart Lung Circ, 2011, 20 （2）：105-110.
8. 　Zimmet AD, Almeida A, Goldstein J, et al. The outcome of cardiac surgery in Dialysis-Dependent patients. Heart Lung Circ, 2005, 14 （3）：187-190.
9. 　Bechtel JF, Detter C, Fischlein T, et al. Cardiac surgery in patients on dialysis：decreased 30-day mortality, unchanged overall survival. Ann Thorac Surg, 2008, 85 （1）：147-153.
10. 　Rahmanian PB, Adams DH, Castillo JG, et al. Early and late outcome of cardiac surgery in dialysis-dependent patients：single-center experience with 245 consecutive patients. J Thorac Cardiovasc Surg, 2008, 135 （4）：915-922.
11. 　Ashrith G, Elayda MA, Wilson JM. Revascularization options in patients with chronic kidney disease. Tex Heart Inst J, 2010, 37 （1）：9-18.
12. 　Amann K, Wanner C, Ritz E. Cross-talk between the kidney and the cardiovascular system. J Am Soc Nephrol, 2006, 17 （8）：2112-2119.
13. 　Tugtekin S, Kappert U, Jarny K, et al. Coronary surgery in dialysis-dependent patients with end-stage renal failure with and without extracorporeal circulation. Thorac Cardiovasc Surg, 2007, 55 （2）：.
14. 　London GM, Marchais SJ, Guérin AP, et al. Arteriosclerosis, vascular calcifications and cardiovascular disease in uremia. Curr Opin Nephrol Hypertens, 2005, 14 （6）：525-531.
15. 　Herzog CA, Ma JZ, Collins AJ. Comparative survival of dialysis patients in the United States after coronary angioplasty, coronary artery stenting, and coronary artery bypass surgery and impact of diabetes. Circulation, 2002, 106 （17）：2207-2211.
16. 　Ashrith G, Lee VV, Elayda MA, et al. Short- and long-term outcomes of coronary artery bypass grafting or drug-eluting stent implantation for multivessel coronary artery disease in patients with chronic kidney disease. Am J Cardiol, 2010, 106 （3）：348-353.
17. 　Horai T, Fukui T, Tabata M, et al. Early and mid-term results of off-pump coronary artery bypass grafting in patients with end stage renal disease：surgical outcomes after achievement of complete revascularization. Interact Cardiovasc Thorac Surg, 2008, 7 （2）：218-221.
18. 　Kamalakannan D, Pai RM, Johnson LB, et al. Epidemiology and clinical outcomes of infective endocarditis in hemodialysis patients. Ann Thorac Surg, 2007, 83 （6）：2081-2086.
19. 　Nucifora G, Badano LP, Viale P, et al. Infective endocarditis in chronic haemodialysis patients：an increasing clinical challenge. Eur Heart J, 2007, 28 （19）：2307-2312.
20. 　Ariyoshi T, Eishi K, Yamachika S, et al. Perioperative and mid-term results of coronary bypass surgery in patients undergoing chronic dialysis. Ann Thorac Cardiovasc Surg, 2006, 12 （4）：257-264.
21. 　Charytan DM, Kuntz RE. Risks of coronary artery bypass surgery in dialysis-dependent patients--analysis of the 2001 National Inpatient Sample. Nephrol Dial Transplant, 2007, 22 （6）：1665-1671.
22. 　喻磊，谷天祥，師恩祎，等．連續性腎臟替代療法改善合并慢性腎臟病冠狀動脈旁路移植術患者的預后．中國胸心血管外科臨床雜志， 2009， 16 （5）：414-416．.
23. 　Kumar VA, Ananthakrishnan S, Rasgon SA, et al. Comparing cardiac surgery in peritoneal dialysis and hemodialysis patients：perioperative outcomes and two-year survival. Perit Dial Int, 2012, 32 （2）：137-141.
24. 　張金洲，易定華，王文，等．腹膜透析治療心臟手術后腎功能衰竭．中國胸心血管外科臨床雜志， 2003， 10 （2）：136-138．.
25. 　Mehrotra R, Chiu YW, Kalantar-Zadeh K, et al. Similar outcomes with hemodialysis and peritoneal dialysis in patients with end-stage renal disease. Arch Intern Med， 2011， 171 （2）：110-118.
26. -88.

《中國胸心血管外科臨床雜志》

血液或腹膜透析患者行體外循環心臟大血管手術的中期結果分析

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《中國胸心血管外科臨床雜志》

血液或腹膜透析患者行體外循環心臟大血管手術的中期結果分析

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

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