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心脏手术后急性肾功能衰竭的治疗
引用本文:郑知非,邱兆昆,龚宝生,任书南.心脏手术后急性肾功能衰竭的治疗[J].上海医学,2002,25(1):29-32.
作者姓名:郑知非  邱兆昆  龚宝生  任书南
作者单位:200030,上海市胸科医院心血管外科北六病区
摘    要:目的 治疗心脏手术后急性肾功能减退或急性肾功能衰竭 ,避免血液透析或减少血透次数 ,减少术后并发症和降低死亡率。方法 从 1998年 1月到 2 0 0 0年 11月 ,5 0例心脏手术病人在术后心功能和循环相对稳定的时候表现为急性肾功能减退或急性肾衰。我们将本组病例分为 4组以比较早期间歇利尿病例 (A1组13例 )、延迟间歇利尿病例 (A2组 7例 )、早期持续利尿病例 (B1组 2 0例 )和延迟持续利尿病例 (B2组 10例 )的治疗效果 ;同时比较各组中最后需要血透的病例进行早期血透和晚期血透的疗效。结果 A1组 :药物治愈 7例(5 3.8% ) ,早期血透 6例 (4 6 .2 % ) ,死亡 1例 (7.7% ) ;A2组 :早期血透 3例 (4 2 .9% ) ,晚期血透 4例 (5 7.1% ) ,死亡 5例 (71.4% ) ;B1组 :药物治愈 18例 (90 .0 % ) ,早期血透 2例 (10 .0 % ) ,无死亡 ;B2组 :药物治愈 3例(30 .0 % ) ,早期血透 5例 (5 0 .0 % ) ,晚期血透 2例 (2 0 .0 % ) ,死亡 3例 (30 .0 % )。结论 在心功能和循环相对稳定的情况下表现为急性肾功能减退或急性肾衰的病例 ,治疗原则是及时诊断、尽早治疗、持续利尿和积极血透。

关 键 词:急性肾功能衰竭  血液透析  心脏手术
修稿时间:2001年2月6日

Treament of acute renal failure complicating cardiac surgery
ZHENG Zhifei,QIU Zhaokun,GONG Baosheng,et al..Treament of acute renal failure complicating cardiac surgery[J].Shanghai Medical Journal,2002,25(1):29-32.
Authors:ZHENG Zhifei  QIU Zhaokun  GONG Baosheng  
Institution:ZHENG Zhifei,QIU Zhaokun,GONG Baosheng,et al. Department of Cardiovascular surgery,Shanghai Chest Hospital,Shanghai 200030
Abstract:Objective To treat acute renal failure complicating cardiac surgery, for avoiding dialysis, decreasing morbidity and mortality. Methods From January 1998 to November 2000, 50 patients manifested acute renal failure or dysfunction despite adequate postoperative cardiac output and stabilized hemodynamic function. Group A (20 patients) were given intermittenly doses of furosemide, while group B (30 patients) were given continuous infusion of furosemide and dopamine with intermittent mannitol and furosemide; subgroup A1 (13 patients) and subgroup B1 (20 patients) were immediately treated after 3 hours of oliguria (urine volume <0.5 ml/kg/h); while subgroup A2 (7 patients) and subgroup B2 (10 patients) were started to treat after serum creatinine level along 110 umol/L or 50% over the baseline in addition to 3 to 2 hours oliguria, this subgroup was further divided into early and late dialysis groups according to the cardiac function and hemodynamic stability before performing dialysis. Results Group A1: diuresis occurred in 7 patients (53.8%), and 6 early dialysis patients (46.2%), among then 1 patient died (7.7%). Group A2: 5 patients (71.4%) died among the 3 early dialysis patients and 4 late dialysis patients. Group B1: diuresis occured in 18 patients (90%) and 2 early dialysis patients (10%) with no death. Group B2: diuresis occured in 3 patients (30%), 5 early dialysis patients and 2 late dialysis patients with 3 death (30%). Conclusion To treat patients manifesting acute renal failure or dysfunction poatoperatively despite stabilized cardiac function and hemodynamics are important, and early diagnosis and treamtnet with diuretics and early dialysis are advocated.
Keywords:Acute renal failure  Dialysis  Cardiac surgery
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