心脏移植术后肾功能衰竭的围手术期处理(附2例报告)

目的报告2例原位心脏移植术后肾功能衰竭的发生及治疗经过,探讨其围手术期处理的初步经验和要点.方法我院自2000年12月一2002年12月共对4例终末期心脏病患者施行同种异体原位心脏移植术,4例均为男性,采用标准原位心脏移植术,术后应用三联免疫治疗的方法抗排异.结果4例患者均获得手术成功,术后未发现超急性排斥反应或急性排斥反应,2例术后1周左右并发急性肾功能衰竭,应用床边连续肾脏替代(CRRT)治疗后,1例存活22d,1例完全康复,随访半年患者心功能恢复Ⅰ～Ⅱ级(NYHA),生活质量良好.结论心脏移植手术后肾功能损害较常见,围手术期的肾功能保护非常重要,如符合手术指征,及早手术治疗是抢救成功的关键.

PERIOPERATIVE MANAGEMENT OF ACUTE RENAL FAILURE AFYER HEART TRANSPLANTATION-A REPORT OF 2 CASES

Objective To discuss the clinical management of 2 patients with acute renal failure after heart transplantation. Methods From Dec. 2000 to Dec. 2002, 4 patients with end - stage dilated car-diomyopathy underwent orthotopic homologous heart transplantation. The triple - drug immunosup-pressive agents treatment of cyclosporine A, cellcept, and prednisolone were applied following transplantation. Results All patients survived postoperation. There was no severe rejective reaction. 2 patients complicated acute renal failure 1 week after operation, who needed continue renal replacement therapy(CRRT) , of the 2 patients, one case survived for 22 days, the other prolonged good life quality . Conclusion Kidney function damage often occured after heart transplantation. The preoperative common situation, the operative infliction, the postoperative monitoring and the medicine might responsible for renal failure. If surgery is needed, to perform operation urgently is the key point.