Tanaka H, Suzuki K, Narisawa T, Ookura T, Kamio Y, Suzuki S, Kitami A, Suzuki T, Takaba T
Department of Thoracic and Cardiovascular Surgery, Showa University Fujigaoka Hospital, 1-30 Fujigaoka Aoba-ku, Yokohama, 227-8501, Japan.
Jpn J Thorac Cardiovasc Surg. 2000 Nov;48(11):703-7. doi: 10.1007/BF03218236.
In dialysis patients, there are two issues to consider, water-electrolyte control and a bypass technique for a calcified aorta. We used continuous hemofiltration for water-electrolyte control and an off-pump bypass with arterial grafting for a calcified aorta.
We performed coronary artery bypass grafting with extracorporeal circulation in 9 cases and without extracorporeal circulation (off-pump bypass) in 3 cases. In 6 cases, the operation was urgent, and in 6 cases the operation was elective.
An average of 3.2 grafts/pt, (the arterial graft: 1.3 grafts/pt) was performed in the pump cases. In the off-pump bypass cases we used arterial grafting only (1.7 grafts/pt). We had 1 early death (sudden death) and 1 hospital death (SLE encephalopathy). One late death due to cerebral bleeding occurred at 2 years later. We used continuous hemofiltration for 2 to 11 days (average 3.9 days) in the pump cases. The off-pump cases could be controlled by conventional hemodialysis.
Continuous hemofiltration was very easily set up with less interference to the hemodynamics. Using an arterial graft with off-pump bypass, an aortic no-touch technique and water control with conventional hemodialysis were possible.
对于透析患者，有两个问题需要考虑，即水电解质控制和钙化主动脉的旁路技术。我们采用持续血液滤过进行水电解质控制，并采用带动脉移植的非体外循环旁路技术处理钙化主动脉。
我们对9例患者进行了体外循环下冠状动脉旁路移植术，对3例患者进行了非体外循环（非体外循环旁路）冠状动脉旁路移植术。其中6例手术为急诊，6例为择期手术。
体外循环手术患者平均每例移植3.2根血管（动脉移植：平均每例1.3根）。在非体外循环旁路手术病例中，我们仅采用动脉移植（平均每例1.7根）。我们有1例早期死亡（猝死）和1例住院死亡（系统性红斑狼疮脑病）。1例患者在2年后因脑出血发生晚期死亡。体外循环手术患者持续血液滤过2至11天（平均3.9天）。非体外循环手术病例可通过常规血液透析控制。
持续血液滤过很容易设置，对血流动力学干扰较小。采用带动脉移植的非体外循环旁路技术、主动脉免接触技术以及常规血液透析进行水分控制是可行的。
