Importance of early dialysis for acute renal failure after an open-heart surgery
Importance of early dialysis for acute renal failure after an open-heart surgery
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DOI：
10.1111/j.1542-4758.2009.00347.x
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发表时间：
2009-01-01
影响因子：
1.3
通讯作者：
Bueket, Suat
中科院分区：
文献类型：
--
作者：
Iyem, Hikmet;Tavli, Mine;Bueket, Suat
冠状动脉疾病是肾功能不全患者死亡的主要原因。在接受冠状动脉旁路移植术的患者中，肾功能障碍被认为是院内和院外死亡率的主要预测因素。从2004年到2007年，我们对2380例没有原发性肾功能衰竭的患者进行了择期开胸手术。在这些患者中，只有185名急性肾衰竭（ARF）患者被纳入研究。患者分为两组：晚期透析组（n=90）和早期透析组（n=95）。晚期透析组患者平均年龄为62.3 +/- 6.4岁，早期透析组患者平均年龄为64.5 +/- 5.2岁。晚期透析组女性32例，男性58例；早期透析组女性36例，男性59例。2380例心内直视手术患者中，只有185例出现急性肾功能衰竭。2380例心内直视手术患者的总死亡率为1.97%。ARF患者死亡率为5.9%。但两组患者住院死亡率无显著差异。术后肺炎、通气时间延长、心律失常、术后血液透析次数、慢性肾功能衰竭的发生、重症监护时间和住院时间、败血症、低心排血量等主要并发症在透析晚期组明显增高。两组患者的死亡率无差异。对术后发生ARF的心内直视手术患者进行早期透析并不能降低死亡率。然而，它降低了发病率、重症监护时间和住院时间，从而降低了患者的费用。
Coronary artery disease is a major cause of death in patients with a renal dysfunction. Among the patients who undergo coronary artery bypass grafting, renal dysfunction is known to be a major predictor of in-hospital and out-of-hospital mortality. From 2004 to 2007, we performed elective open-heart surgeries on 2380 patients in whom there was no primary renal failure. Of those patients, only 185 in whom acute renal failure (ARF) was developed were included in the study. The patients were divided into 2 groups: a late dialysis group (n=90) and an early dialysis group (n=95). The mean age of the patients was 62.3 +/- 6.4 in the late dialysis group and 64.5 +/- 5.2 in the early dialysis group. There were 32 female and 58 male patients in the late dialysis group and 36 female and 59 male patients in the early dialysis group. Acute renal failure developed only in 185 patients out of 2380 open-heart surgery patients. The overall mortality in the 2380 open-heart surgery patients was 1.97%. Mortality among the ARF patients was 5.9%. However, there was no significant difference in hospital mortality between the 2 groups. Major complications, such as postoperative pneumonia, prolonged ventilation time, arrhythmia, the number of times postoperative hemodialysis was performed, development of chronic renal failure, time spent in the intensive care unit and the period of hospitalization, sepsis, and low cardiac output, were significantly higher in the late dialysis group. There was no difference in mortality between the 2 groups. Early dialysis for open-heart surgery patients who develop ARF postoperatively does not decrease mortality. However, it decreases morbidity, the amount of time spent in intensive care, and the period of hospitalization and thus reduces patient costs.