慢性肾功能不全合并冠心病病人行冠状动脉旁路移植术15例

目的 :探讨慢性肾功能不全合并冠心病病人行冠状动脉旁路移植术 (CABG)的安全性及可行性。　　方法 :1996年 6月至 2 0 0 1年 6月术前诊断为慢性肾功能不全合并冠心病的病人 15例。 9例在体外循环下行CABG ,6例行非体外循环心脏跳动下CABG (OPCABG)。　　结果 :9例在体外循环下手术的病人 ,术后早期肾功能指标均较术前差 ;6例行OPCABG的病人 ,术后早期肾功能较术前无明显变化。围术期腹膜透析 4例 ,血液透析 2例 ,其中 1例行术中血液透析 ,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 ,经过适当的术式选择及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CABG ,达到改善症状延长生命的目的。

Coronary Artery Bypass Grafting in 15 Patients With Chronic Renal Insufficiency

Objective:To evaluate the safety and feasibility of coronary artery bypass grafting(CABG) in patients with chronic renal insufficiency recorded from 1996 to 2001. Methods:Among 15 patients with chronic renal insufficiency complicated by coronary heart disease 9 underwent CABG under cardiopulmonary bypass(CPB) and 6 underwent off pump CABG(OPCABG). All patients received active management during the perioperative period. Results:The indexes of renal function in early stage of postoperation were poorer than those of preoperation in 9 patients under CPB,while no obvious changes were found in the OPCABG patients.The renal function in OPCABG patients was greatly improved after proper treatment.One received hemodialysis at operation,4 peritoncal dialysis and 1 hemodialysis after operation.No patients died during operation.One died of multi organic failure in the third day after operation. Conclusion:It is suggested that the majority of patients with renal insufficiency can tolerate CABG if proper operating method is used and active treatment is planned during peri operative period.