天津医药 ›› 2017, Vol. 45 ›› Issue (9): 973-976.

• 临床研究 • 上一篇    下一篇

冠脉搭桥术治疗尿毒症规律透析合并冠心病患者的临床观察

柴军武,王凯,孔祥荣△,陈洪磊,薛奋龙,王维铁,周巍   

  1. 天津市第一中心医院心血管外科(邮编 300192)
  • 收稿日期:2017-03-02 修回日期:2017-07-21 出版日期:2017-09-15 发布日期:2017-09-25
  • 通讯作者: 柴军武 E-mail:junwu1997@sina.com

Coronary artery surgical treatment in patients with uremia

CHAI Jun-wu, WANG Kai, KONG Xiang-rong△, CHEN Hong-lei, XUE Fen-long, WANG Wei-tie, ZHOU Wei   

  • Received:2017-03-02 Revised:2017-07-21 Published:2017-09-15 Online:2017-09-25

摘要: 摘要:目的 总结慢性肾功能不全尿毒症期患者合并重症冠脉病变的外科治疗经验,降低围术期风险。方法 回顾性分析我院 2009 年 2 月—2016 年 12 月收治的 16 例术前诊断为肾功能不全尿毒症期合并冠脉三支严重病变 行冠脉搭桥术患者的资料,其中非体外搭桥 8 例,体外循环下搭桥 6 例,体外循环下搭桥+室壁瘤切除 1 例,体外循 环下搭桥同期三尖瓣置换 1 例。记录患者术前与术后即刻、术后第 2 天、术后 1 周肾功能变化,超声心动图评价心 功能状态,观察术后心绞痛改善情况。结果 14 例患者术后 24 h 内顺利脱离呼吸机治疗。1 例术后 65 h 拔除气管 插管,期间间断床旁血液滤过治疗;1 例术后第 5 天二次气管插管,第 7 天多器官功能衰竭死亡。16 例患者 ICU 入 住时间(125.5±21.6)h,住院时间(28.6±7.4)d,术后第 2 天的血肌酐(sCr)和尿素氮(BUN)较术前升高(P < 0.05)。术 后随访 15 例(末次随访时间 2017 年 2 月)患者心功能Ⅰ~Ⅱ级、射血分数(EF)均>0.40,无心绞痛发生。结论 透析 依赖尿毒症合并重症冠心病患者行冠脉搭桥相对安全,可明显改善心绞痛症状,临床效果满意。

Abstract: Abstract:Objective To summarize the experience of surgical treatment in patients with uremia and severe coronary artery disease, and reduce the perioperative risk thereof. Methods Sixteen chronic renal failure patients who were received haemodialysis and underwent coronary artery bypass grafting (CABG) during the period of February 2009 to December 2016 in Tianjin First Central Hospital were assessed in this retrospective study. Of the 16 patients, 8 patients and 6 patients were treated with off pump and on pump CABG respectively, one patient was treated with CABG and resection of ventricular aneurysm, and one patient was treated with CABG and tricuspid valve replacements. The renal function changes in preoperative and postoperative periods, 2- day and 1- week after surgery were observed. Echocardiography was used to evaluate cardiac function. The improvement of angina was recorded. Results Fourteen patients were successfully withdrawn from ventilator therapy within 24 h after surgery. The tracheal intubation was removed 65-hour after surgery in one patient. One patient died of multiple organ failure on the seventh day after surgery. The average length of ICU staying and in- hospital stay were (125.5 ± 21.6) h and (28.6 ± 7.4) days respectively. The serum creatinine (sCr) and blood urea nitrogen (BUN) were higher in two days after surgery than those before the operation (P < 0.05). Fifteen patients which followed up (the final follow-up date was February 2017) showing cardiac function Ⅰ-Ⅱ, ejection fraction (EF) >0.40, and no angina occurred. Conclusion CABG is relatively safe for patients with end- stage renal disease and severe coronary artery disease. CABG can significantly eliminate angina symptoms with satisfactory clinical effect.