Manché Alexander, Casha Aaron, Rychter Jacek, Farrugia Emanuel, Debono Miriam
Department of Cardiothoracic Surgery, Mater Dei Hospital, Malta.
Interact Cardiovasc Thorac Surg. 2008 Oct;7(5):829-32. doi: 10.1510/icvts.2008.181909. Epub 2008 Jul 4.
Acute kidney injury following cardiac surgery (AKICS) remains a frequent cause of major morbidity and mortality. The aim of this study was to examine the influence of timing of dialysis. A retrospective analysis of 3528 patients undergoing cardiac surgery between April 1995 and July 2006 was performed. In group 1 (April 1995-January 2000) intermittent haemodialysis was resorted to when other supportive measures failed. In group 2 (January 2000-July 2006) intermittent haemodialysis was commenced immediately when oliguria did not respond to fluid replacement or single-dose diuretics. In group 1, 49/1511 (3.2%) patients developed AKICS. Thirty-four patients did not receive dialysis and six patients died (18%). Of the remaining 15 patients who underwent dialysis, 13 died (87%). The overall mortality for group 1 AKICS patients was 19/49 (39%). In group 2, 87/2017 (4.3%) patients developed AKICS. Thirty-one patients did not require dialysis and none died. Of the 56 patients who were dialysed, 14 died (25%). During January 2005-July 2006, mortality following dialysis fell further to 17% (4/24). The overall mortality for group 2 patients developing AKICS was 14/87 (16%). Although the incidence of AKICS increased from 3.2% to 4.2%, earlier dialysis resulted in significantly improved survival (P=0.00001).
心脏手术后急性肾损伤（AKICS）仍然是导致严重发病和死亡的常见原因。本研究的目的是探讨透析时机的影响。对1995年4月至2006年7月期间接受心脏手术的3528例患者进行了回顾性分析。第1组（1995年4月至2000年1月）在其他支持措施无效时采用间歇性血液透析。第2组（2000年1月至2006年7月）在少尿对补液或单剂量利尿剂无反应时立即开始间歇性血液透析。在第1组中，49/1511（3.2%）例患者发生AKICS。34例患者未接受透析，6例死亡（18%）。其余15例接受透析的患者中，13例死亡（87%）。第1组AKICS患者的总体死亡率为19/49（39%）。在第2组中，87/2017（4.3%）例患者发生AKICS。31例患者不需要透析，无一例死亡。在56例接受透析的患者中，14例死亡（25%）。在2005年1月至2006年7月期间，透析后的死亡率进一步降至17%（4/24）。第2组发生AKICS患者的总体死亡率为14/87（16%）。尽管AKICS的发生率从3.2%增至4.2%，但早期透析显著提高了生存率（P = 0.00001）。
