肾功能不全患者关节置换围手术期处理

目的探讨合并慢性肾功能不全患者行全髋或全膝关节置换术的围手术期处理。方法回顾性分析2006年1月至2012年6月合并慢性肾功能不全患者行全髋或全膝关节置换病例资料,对围手术期处理以及合并症、并发症进行分析总结。结果共17例患者纳入本次研究,其中男性10例,女性7例,平均年龄56岁,肾功能不全代偿期9例,氮质血症期8例。术前合并干燥综合征2例,房室传导阻滞3例,抗中性粒细胞胞质抗体相关性血管炎1例,肾结石5例,尿路感染4例,高血压8例,Ⅱ型糖尿病10例,痛风2例,贫血13例,冠状动脉狭窄支架植入术后1例。术前准备平均8d,平均住院18d,肾功能不全代偿期和氮质血症期患者术后各时间点血肌酐与术前相比无明显差异。术后并发症包括2例出现肺部感染,4例切口渗液,6例切口周围大片皮下瘀斑。无肾功能恶化、切口感染等病例发生,无死亡病例。结论肾功能不全患者行关节置换围手术期并发症发生率较高,但是经过缜密的围手术期处理,选择好手术时机,这类患者完全可以安全度过手术期。

Perioperative Management of Patients with Chronic Kidney Dysfunction for Arthroplasty

Objective To explore the perioperative management of patient with chronic kidney dysfunction undergoing total knee or hip arthroplasty.Methods We restrospective analyzed medical records of patients with chronic kidney dysfunction who had total knee or hip arthroplasty in our hospital between Jaunary 2006and June 2012,and summarized the combined diseases,complications and perioperative management.Results 17patients including 10males and 7 females were included in this study,the average age was 56years.There were 9renal failure in decompensation period and 8nephropathy azotemia.The combined diseases include 2sicca syndrome,3atrioventricular block,1ANCA associated systemtc Vasculitis,5kidney stone,4urinary tract infection,8hypertension,10type 2diabetes,2gout,13anaemia,1Coronary artery stenosis after stent implantation.The average preoperative preparation period was 8days,and the average hospital stays was 18days.There were no significant difference in BUN between preoperation and postoperation.The postoperative complication include 2pulmonary infection,4incision ooze,6ecchymosis.There were no case of deterioration of renal function,incision infection and death.Conclusion Although the incidence of postoperative complication is high in patient with chronic kidney dysfunction undergoing total knee or hip arthroplasty,meticulously perioperative management could help these patients get through operation safely.