心脏手术与急性肾功能不全

目的　分析心脏手术后急性肾功能不全的原因 ,提出围手术期的处理要点。方法　对 13 45例心脏手术后发生肾功能不全的 2 82例的临床资料进行分析 ,其中轻度肾功能不全 189例 ,中度 69例 ,重度 14例 ,极重度 10例。结果　总的肾功能不全的发生率 2 0 97% (2 82 /13 45 ) ,总住院死亡率 3 712 % (4 2 /13 45 ) ,2 82例肾功能不全患者住院死亡 2 4例(8 5 1% ) ,术前伴发病、心功能分级、手术种类和心肺转流时间与术后肾功能不全的发生率有显著差异。结论　心脏手术后肾功能不全的发生和轻重程度 ,与术前伴发病、心功能分级、手术种类和心肺转流时间有密切关系。轻度、中度肾功能不全以强心、利尿、扩血管、保护肾功能为主 ,中度和重度肾功能不全者以腹膜透析为主 ,部分重度和极重度肾功能不全者以血液透析治疗为主     

Acute adrenal insufficiency after cardiac surgery

Adrenal insufficiency after cardiac surgery can easily be confused during the course of an immediate unstable postoperative period. If unrecognized, this condition may cause serious morbidity and can be fatal. We report on a 43-yr-old female patient with chronic known adrenal insufficiency, who, despite her adequate preoperative replacement therapy, presented with one episode of acute hypoadrenal crisis after elective open heart surgery, which could serve as a model to illustrate the salient clinical features and possible problems in this setting for diagnosing this problem to patients in whom chronic adrenal insufficiency remains unknown.     

Renal insufficiency and treatment of persistent cardiac insufficiency with converting enzyme inhibitor

The purpose of this retrospective study was to consider impaired renal function in patients with severe congestive heart failure after converting enzyme inhibition and to emphasize the characteristics of this population. The study concerned 26 patients (pts), 72.5 +/- 8.1 years old, with a severe congestive heart failure (NYHA Class IV). Before treatment serum creatinine was slightly increased and the introduction of angiotensin converting enzyme inhibitor (ACEI) - Captopril 58.9 +/- 17.3 mg/j or enalapril 9.2 +/- 4.4 mg - impaired renal function from 132.0 +/- 50.7 mumol/l to 183.5 +/- 139.3 mumol/l (n = 26; p less than 0.05). Patients were separated in 3 groups: in group I; 15 pts, serum creatinine remained unchanged under ACEI in despite of the significant decrease of blood pressure (BP); from 140.7 +/- 24.0/82.5 +/- 13.4 to 120.3 +/- 12.8/71.8 +/- 8.7 mmHg (p less than 0.01). The cause of heart failure was an ischemic heart disease (IHD) in 15 patients (chi 2 test, p less than 0.05), a dilated cardiomyopathy in 4 pts and an aortic or mitral valvular regurgitation in 2 pts. In contrast renal function was significantly impaired in group II; serum creatinine increased from 120.8 +/- 25.2 to 189.0 +/- 80.7 mumol/l under ACEI. BP remained unchanged 136.9 +/- 29.0/78.1 +/- 4.9 and 118.7 +/- 13.6/75.6 +/- 7.6 mmHg respectively before and after treatment. There was 4 pts with dilated cardiomyopathy, 4 pts with mitral or aortic valvular regurgitation and only one with IHD. The introduction of an ACEI in two pts--group III--with severe tricuspid regurgitation induced an acute and reversal renal failure (serum creatinine at 600 mumol/l).     

Diastolic dysfunction--predictor of cardiac remodeling in arterial hypertension in young males

For the study of the state of central hemodynamics and diastolic function of the left and right ventricle in formation of arterial hypertension (AH) with method of computer polyrheocardiography 76 males of mean age of 35.1 +/- 3.2 years were examined. The first group included 26 cases with high normal BP (systolic BP (SBP) 130-139 mm Hg, diastolic (DBP) 85-89 mm Hg--prehypertension, the second group was consisted of 30 cases with essential AH 1 stage (SBP 140-159 mm Hg, DBP 90-99 mm Hg), who did not receive antihypertensive therapy. The control group was consisted of 20 practically health young males. As a result of performed study at early stages of AH there were revealed lop-sided changes both of central hemodynamics and a diastolic function of both ventricles, which progressively increase along with elevation of AH stage. Diastolic dysfunction of left and right ventricle appears at the prehypertension stage and stage 1 arterial hypertension and precedes heart remodeling.     

Modern principles of diagnostics of chronic cardiac insufficiency

Chronic cardiac insufficiency manifests itself in a number of clinical syndromes with signs and symptoms characterized by low specificity and sensitivity. ESC and ACC/AHA experts propose to use brain natriuretic peptide (BNP) and/or N-terminal BNP propeptide (NT-proBNP) levels in combination with tissue velocity imaging (TVI) to facilitate diagnostics of this condition. BNP and NT-proBNP levels are highly specific and sensitive indicators of left ventricular myocardium overload while TVI reveals chronic cardiac insufficiency in the asymptomatic phase of its development. Q-analysis of TVI provides data on global and local myocardial contraction and relaxation and allows objective quantitative evaluation of these functions in lieu of less accurate subjective characteristic. A number of cohort studies have confirmed high specificity and sensitivity of TVI, BNP and NT-proBNP levels at the early stages of chronic cardiac insufficiency.