Heart valve replacement for patients with end-stage renal disease in Japan.
Heart valve replacement for patients with end-stage renal disease in Japan.
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日本为终末期肾病患者进行心脏瓣膜置换术。
DOI：
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发表时间：
2010
期刊：
影响因子：
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通讯作者：
Y. Misawa
中科院分区：
文献类型：
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作者：
Y. Misawa
对于心脏病和伴发的需要慢性透析的终末期肾病患者，人工瓣膜的选择存在一些争议。透析患者的预期寿命往往较短。在日本，透析患者的一年存活率在20世纪80年代为80%，但在本世纪头十年超过85%。在过去的20年里，5年生存率为54%-60%。此外，10年和15年生存率分别为35%-42%和23%-31%。然而，在美国，1996年至2000年开始透析的患者的5年生存率仅提高到35%，而6岁、7岁和80岁的慢性透析患者的预期寿命分别为5.3-6.2年、3.8-4.5年和2.7-3.2年。因此，日本的透析患者的预期寿命比美国的患者要长。一些外科医生更喜欢使用生物瓣膜，因为透析患者的出血性并发症发生率很高。他们对使用机械瓣膜的透析患者是否使用抗凝治疗犹豫不决。其他人更喜欢机械瓣膜，因为在钙代谢异常的透析患者体内植入的生物瓣膜有可能导致早期结构功能障碍，这可能会导致术后早期生物瓣膜上的钙沉积。日本透析患者的预期寿命相对较高。在日本为这些患者选择人工心脏瓣膜时，应该考虑到生物瓣膜早期钙化的潜在风险。
There is some controversy regarding the choice of prosthetic valves in patients with heart disease and concomitant end-stage renal disease requiring chronic dialysis. Dialysis patients tend to have a short life expectancy. In Japan, the 1-year survival of the dialysis patients was 80% in the 1980s, but exceeds 85% in the 2000s. The 5-year survival has been 54%-60% for the past 20 years. In addition, the 10-year and 15-year survivals have been 35%-42% and 23%-31%, respectively. However, in the United States, the 5-year survival had only improved to 35% among patients who started dialysis between 1996 and 2000, and the life expectancies of chronic dialysis patients in their sixth, seventh and eighth decades is 5.3-6.2 years, 3.8-4.5 years, and 2.7-3.2 years, respectively. The life expectancy of dialysis patients in Japan is thus better than that of patients in the United States. Some surgeons prefer to use bioprosthetic valves because of a high rate of hemorrhagic complications in dialysis patients. They are hesitant to use anticoagulation therapy in dialysis patients with mechanical valves. Others prefer mechanical valves because of the potential for early structural dysfunction of bioprosthetic valves implanted in the dialysis patients with abnormal calcium metabolism, which can cause calcium deposition on the bioprosthetic valves during the early postoperative period. The life expectancy of dialysis patients in Japan is relatively high. The potential risk of early calcification of bioprosthetic valves should be taken into account when choosing prosthetic heart valves for these patients in Japan.