Horst M, Mehlhorn U, Hoerstrup S P, Suedkamp M, de Vivie E R
Clinic for Cardiothoracic Surgery, University of Cologne, Germany.
Ann Thorac Surg. 2000 Jan;69(1):96-101. doi: 10.1016/s0003-4975(99)01133-9.
End-stage renal disease is known to be an important risk factor complex for cardiac operations performed with cardiopulmonary bypass.
To investigate the influence of preoperative status on perioperative mortality and morbidity, we retrospectively analyzed data from 65 patients (20 women and 45 men with a mean age of 58.8+/-10.0 years [+/-standard deviation]) with end-stage renal disease who were on dialysis and who underwent a cardiac surgical procedure between 1988 and 1998.
Fifty-one percent of the patients had isolated coronary artery bypass grafting, 35% had replacement or reconstruction of one valve or two valves, and 14% underwent combined coronary artery bypass grafting and valve replacement. The perioperative mortality rate was 13.8% with 78% (7 of 9) of deaths occurring in patients having a valve procedure. Six of the 9 patients who died had compromised left ventricular function preoperatively, and all 9 were in New York Heart Association class III or IV. Mean preoperative duration of dialysis was longer (80+/-70 months) in the 9 patients who died compared with that in the surviving 56 patients (45+/-49 months) (p = 0.05). We found dyspnea at rest, duration of dialysis of 60 months or more, combined procedures (coronary artery bypass grafting and valve operation), and New York Heart Association class IV to be associated with a higher relative risk for perioperative death. Neither angina pectoris nor isolated coronary artery bypass grafting was associated with increased relative risk for perioperative death. However, after a cardiac operation, mortality in patients with end-stage renal disease was substantially higher than in those with normal renal function.
These data are comparable with those in the literature and possibly suggest that both indications and referral for surgical intervention have been delayed in patients who have end-stage renal disease combined with coronary artery disease, valve disease, or both. The delay may contribute to the relatively high perioperative mortality.
终末期肾病是体外循环心脏手术的一个重要复杂危险因素。
为研究术前状态对围手术期死亡率和发病率的影响，我们回顾性分析了1988年至1998年间65例接受透析的终末期肾病患者（20例女性和45例男性，平均年龄58.8±10.0岁[±标准差]）的数据，这些患者均接受了心脏外科手术。
51%的患者接受单纯冠状动脉搭桥术，35%的患者接受一个或两个瓣膜置换或重建，14%的患者接受冠状动脉搭桥术和瓣膜置换联合手术。围手术期死亡率为13.8%，其中78%（9例中的7例）的死亡发生在接受瓣膜手术的患者中。9例死亡患者中有6例术前左心室功能受损，所有9例均为纽约心脏协会III级或IV级。与56例存活患者（45±49个月）相比，9例死亡患者术前平均透析时间更长（80±70个月）（p = 0.05）。我们发现静息时呼吸困难、透析时间60个月或更长、联合手术（冠状动脉搭桥术和瓣膜手术）以及纽约心脏协会IV级与围手术期死亡的相对风险较高相关。心绞痛和单纯冠状动脉搭桥术均与围手术期死亡相对风险增加无关。然而，心脏手术后，终末期肾病患者的死亡率显著高于肾功能正常的患者。
这些数据与文献中的数据相当，可能表明终末期肾病合并冠状动脉疾病、瓣膜疾病或两者兼有的患者，手术干预的指征和转诊均有所延迟。这种延迟可能导致相对较高的围手术期死亡率。
