慢性肾功能不全心脏病人行体循环手术的围术期处理

目的 探讨合并慢性肾功能不全心脏病人行体外循环手术的安全性。方法 对慢性肾功能不全的病人15例，施行了体外循环手术，其中氮质血症8例，肾功能不全代偿期5例，尿毒症期2例，在心脏手术围术期均给予积极治疗。结果 9例病人术后早期肾功能指标均较术前差；6例病人术后早期肾功能较术前无明显变化。围术期腹透4例，血透2例，其中一例行术中血透，肾功能指标均有所改善；全组无术中死亡，1例术后第3天死于多器官功能衰竭。结论 术前肾功能不全的病人，经过积极的术中及围术期处理，大多可以安全渡过肾功能衰竭关，接受体外循环手术，达到改善症状延长生命的目的。

Cardiopulmonary Bypass In Patients With Chronic Renal Insufficiency

Objective To evaluate the safety of cardiopulmonary bypass grafting on patients with chronic renal disease.Methods Before surgery,15 patients were diagnosed with chronic renal disease. Among them 5 patients were in compensatory stage of renal failure, 8 were azotenesic and 2 uremic. All patients received active management during perioperative period.Results The indexes of renal function in early stage of postoperation were worse than those in preoperation in 9 patients, while the indexes did not obvious change in other 6 patients. The renal function was greatly improved after proper treatment. There were 4 patients with peritoneal dialysis and 2 patients with hemodialysis,one of which hemodialysis during operation. None of patients was died during operation, while one patient died of function insufficiency with several organs on the third day after operating.Conclusion It is suggested that the majority of patients with renal insufficiency can recover with active and proper treatment during perioperative period.