Garwood Susan
Department of Anesthesiology, Yale University School of Medicine, New Haven, CT 06510, USA.
Semin Cardiothorac Vasc Anesth. 2004 Sep;8(3):227-41. doi: 10.1177/108925320400800305.
The new millennium ushered in a number of changes in cardiac surgery. Off-pump coronary artery bypass surgery became technically easier so that multivessel surgery became less of a challenge and cardiologists were supplied with new catheters that accessed lesions that were previously thought of as being unapproachable. New drugs were introduced that made the management of heart failure patients feasible on an outpatient basis, and new devices extend the bridging period to transplantation. However, these advances have not necessarily been attended by significant improvements in outcome, possibly because the less challenging a procedure becomes, the sicker the patients that can be managed. This observation is particularly true with the incidence and outcome of renal failure after cardiac surgery. Bypass factors have been manipulated without much effect, and the traditional drugs that were found to increase renal blood flow in animal experiments did not translate into clinical improvement in renal outcome. Recent research has given us insight into the pathophysiology of ischemic acute renal failure, and it has been found that the paradigm was not as simple as previously thought, possibly accounting for the failure of the more traditional renal drugs (dopamine, mannitol and diuretics). However, these new insights open up the possibility of novel targets for renal protection and repair.
新千年迎来了心脏外科领域的诸多变革。非体外循环冠状动脉搭桥手术在技术上变得更加简便，多支血管手术不再那么具有挑战性，并且为心脏病专家提供了新型导管，可用于处理以前被认为无法触及的病变。新型药物的出现使心力衰竭患者的门诊管理成为可能，新型设备延长了移植前的过渡阶段。然而，这些进展并不一定伴随着显著的预后改善，可能是因为手术难度越低，所能处理的患者病情越重。这一观察结果在心脏手术后肾衰竭的发生率和预后方面尤为明显。体外循环相关因素虽经调整但效果不佳，在动物实验中发现能增加肾血流量的传统药物并未转化为临床肾脏预后的改善。最近的研究让我们深入了解了缺血性急性肾衰竭的病理生理学，并且发现情况并非如之前认为的那么简单，这可能是更传统的肾脏药物（多巴胺、甘露醇和利尿剂）效果不佳的原因。然而，这些新的见解为肾脏保护和修复的新靶点开辟了可能性。
