Yamamoto Y, Kobayashi J, Miyashita K, Furutera R, Nishiyama K, Goto A, Kaneko Y
Department of Cardiovascular Surgery, Japanese Red Cross Medical Center, Tokyo, Japan.
Kyobu Geka. 2008 Jul;61(7):525-9.
Surgical intervention on cardiovascular disorders in patients with hemodialysis dependent renal failure improves their life expectancy, but carries high surgical mortality. Decision on the indication of surgery as well as on its timing has crucial impact on surgical outcome. We retrospectively analyzed the data of 21 hemodialysis dependent patients who had undergone cardiovascular surgery in our institution from May 2001 to May 2005 to elucidate the appropriate indication and timing of surgical intervention. The study revealed early mortality (< 30 days) of 4.8% and 5 year survival rate of 83.5%. Risk factors for poor prognosis were older age, and longer hemodialysis history. Despite the opinions advocating early surgery in these patients, we adopted a surgical strategy to wait until patients' condition is optimized. Low surgical mortality and high long-term survival of our surgical series indicated appropriateness of our strategy on the timing of surgery. However, extremely low long-term mortality rate raised the concern that our surgical indication might have been too conservative.
对依赖血液透析的肾衰竭患者的心血管疾病进行手术干预可提高其预期寿命，但手术死亡率很高。手术适应症及手术时机的决策对手术结果有至关重要的影响。我们回顾性分析了2001年5月至2005年5月在我院接受心血管手术的21例依赖血液透析患者的数据，以阐明手术干预的合适适应症和时机。研究显示早期死亡率（<30天）为4.8%，5年生存率为83.5%。预后不良的危险因素是年龄较大和血液透析病史较长。尽管有观点主张对这些患者尽早进行手术，但我们采取的手术策略是等到患者状况优化后再进行手术。我们手术系列的低手术死亡率和高长期生存率表明我们在手术时机方面的策略是合适的。然而，极低的长期死亡率引发了人们对我们的手术适应症可能过于保守的担忧。
