Luckraz Heyman, Gravenor Mike B, George Ravi, Taylor Sue, Williams Andrew, Ashraf Saeed, Argano Vincenzo, Youhana Aprim
Cardiothoracic Unit, Morriston Hospital, Swansea SA6 6NL, UK.
Eur J Cardiothorac Surg. 2005 May;27(5):906-9. doi: 10.1016/j.ejcts.2005.01.057.
The development of acute renal failure following cardiac surgery is a rare but devastating complication with high morbidity and mortality. This study aimed to assess the incidence of acute renal failure necessitating continuous renal replacement therapy (CRRT) in patients who required cardiopulmonary bypass, to determine the factors associated with mortality and to evaluate long-term outcome.
Patients who underwent cardiac surgery between October 1997 and 2003 and treated with CRRT were included (n=98). Six patients were then excluded (already in established renal failure pre-operatively) and one patient lost to follow-up. A retrospective analysis was carried out.
Overall CRRT was used in 2.9% (92/3172). The mean (SD) age of patients was 68 (10) years. Their mean pre-operative creatinine level and duration of cardiopulmonary bypass were 154 (87)micromol/l and 160 (84)min, respectively. Mean duration from surgery to establishment of CRRT was 50 (42)h. Mean creatinine level prior to hospital discharge was 168 (93)micromol/l. Thirty-day mortality was 42%. Significant risk factors for death were complex procedures (odds ratio=9.9), gastro-intestinal complications (OR=7.2), cross-clamp time over 88min (OR=5.9), re-exploration (OR=4.0) and patients age over 75 years (OR=3.3). Actuarial 1 and 5-year survivals (95% CI) were 53 (43, 63) % and 52 (42, 62) %, respectively. Only 2 (2.2%) patients required long term renal support.
Acute renal failure necessitating the use of CRRT is a rare but serious complication post cardiopulmonary bypass. In the long-term, surviving patients are not likely to require further renal support.
心脏手术后发生急性肾衰竭是一种罕见但极具破坏性的并发症，其发病率和死亡率都很高。本研究旨在评估需要体外循环的患者中需要持续肾脏替代治疗（CRRT）的急性肾衰竭的发生率，确定与死亡率相关的因素，并评估长期预后。
纳入1997年10月至2003年期间接受心脏手术并接受CRRT治疗的患者（n = 98）。然后排除6例患者（术前已处于既定肾衰竭状态），1例患者失访。进行了回顾性分析。
总体而言，CRRT的使用率为2.9%（92/3172）。患者的平均（标准差）年龄为68（10）岁。他们术前的平均肌酐水平和体外循环时间分别为154（87）微摩尔/升和160（84）分钟。从手术到开始CRRT的平均时间为50（42）小时。出院前的平均肌酐水平为168（93）微摩尔/升。30天死亡率为42%。死亡的显著危险因素包括复杂手术（比值比=9.9）、胃肠道并发症（OR=7.2）、交叉钳夹时间超过88分钟（OR=5.9）、再次手术探查（OR=4.0）以及患者年龄超过75岁（OR=3.3）。1年和5年的精算生存率（95%可信区间）分别为53（43, 63）%和52（42, 62）%。只有2例（2.2%）患者需要长期肾脏支持。
需要使用CRRT的急性肾衰竭是体外循环后一种罕见但严重的并发症。从长期来看，存活的患者不太可能需要进一步的肾脏支持。
