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find Keyword " 腹膜透析" 2 results
  • 成人心内直视手术后急性肾功能衰竭的治疗

    目的 探讨体外循环心脏手术后发生急性肾功能衰竭的治疗方法及疗效。 方法 回顾性分析2011年1月至2012年7月福建医科大学附属协和医院33例行体外循环心脏手术后发生急性肾功能衰竭患者的临床资料,其中男21例,女12例;年龄25~67 (45.21±7.27) 岁。28例采用床旁连续肾脏替代疗法治疗,5例采用腹膜透析联合间歇床旁连续肾脏替代疗法治疗。对比分析经两种治疗方法患者治疗前、后的尿量、尿素氮、血肌酐、血钾和平均动脉压的变化。 结果 33例患者经床旁连续肾脏替代疗法或腹膜透析联合间歇床旁连续肾脏替代疗法治疗后血钾、血肌酐和尿素氮较治疗前明显降低,平均动脉压治疗6 h后较治疗前升高(P<0.05)。围术期死亡9例,死亡率为27.27%,主要死亡原因为多器官功能衰竭、重症肺部感染合并气道出血、恶性心律失常和消化道出血等。24例患者于治疗后5~14 d尿量恢复正常,肾功能指标正常。随访24例,随访3个月,复查肾功能各项指标均正常。 结论 床旁连续肾脏替代疗法治疗心脏手术后急性肾功能衰竭可获得满意的治疗效果,但应监测电解质及出凝血情况。对有出血倾向及血小板减少症患者采用腹膜透析联合间歇床旁连续肾脏替代治疗,也可获得良好的疗效。

    Release date:2016-08-30 05:46 Export PDF Favorites Scan
  • Mid-term Results of Cardiovascular Surgery Employing Extracorporeal Circulation in Patients Dependent on Dialysis

    Objective To summarize our experience of cardiovascular surgery for patients dependent on dialysis, and evaluate its safety and efficacy.?Methods?Clinical data of 10 consecutive patients dependent on maintenance dialysis underwent cardiovascular operations between Dec. 2004 and April 2011 in Peking Union Medical College Hospital were analyzed retrospectively. There were 6 male and 4 female patients, aged between 23 to 71 (57.6±13.2) years. They were put on dialysis 3-98 (25.2±30.6) months prior to operation due to diabetic nephropathy in 6 patients, chronic glomerulitis in 3 patients and systemic lupus erythemus in 1 patient, and 8 were dependent on hemodialysis and 2 on peritoneal dialysis. Five patients underwent coronary artery bypass grafting, one underwent Bentall procedure,two underwent aortic valve replacement, one underwent mitral valve replacement, and one underwent superior vena cava thrombectomy and patch repair. Patients underwent dialysis on the day before elective operation, followed by continuous ultra-filtration during cardiopulmonary bypass, and then bedside heparin-free continuous veno-venous hyperfiltration-dialysis started 5-32 hours after the operation. Conventional peritoneal dialysis or hemodialysis was resumed 4-7 days after operation.?Results?All operations were successfully completed. Cardiopulmonary bypass time was (125.8±33.5)minutes, aortic clamp time was(77.2±25.5) minutes. One in-hospital death occurred due to septic shock after deep chest wound infection. One patient underwent re-exploration due to pericardial temponade to achieve hemostasis. Three patients experienced atrial fibrillation and were all converted to sinus rhythm by amiodarone. Nine patients recovered to discharge and were followed-up for 8-76 months. Two late deaths occurred due to intracranial hemorrhage and liver carcinoma respectively. Seven survived patients were all in New York Heart Association grade II functional class, and none of them experience major advertent cardiac events related to grafts or prosthetic valve. One patient switched to hemodialysis 14 months after discharge due to peritonitis.Conclusion?Cardiovascular surgery can be practiced in patients dependent on maintenance hemodialysis or peritoneal dialysis with appropriate peri-operative management, so that symptoms can be relieved and quality of life improved.

    Release date:2016-08-30 05:50 Export PDF Favorites Scan
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