Heikkinen L, Harjula A, Merikallio E
Ann Chir Gynaecol. 1985;74(5):203-9.
Open-heart surgery was performed on 1686 adult patients between 1980 and 1984. The patients were operated on using cardiopulmonary bypass procedures (CPB). Fifteen patients developed acute renal failure (ARF) after CPB, i.e. the incidence of ARF was 0.9%. All these patients were treated by peritoneal dialysis or haemodialysis. Pre-operative possible risk factors in the ARF group were compared to those in a control group of 30 patients (15 consecutive coronary artery bypass grafting and 15 consecutive valve repair procedures) experiencing no complications. Age, New York Heart Association (NYHA) classification, ejection fraction, cardiac volume and left ventricular end-diastolic pressure were not risk factors for the development of renal failure. The incidence of thrombocytopenia after CPB was statistically significantly different between the control and ARF groups. The mortality from ARF was 66.6%. The causes of death were peri-operative myocardial infarction, infection and gastrointestinal bleeding. CPB time, perioperative events and postoperative infection were the main factors contributing to ARF. Renal failure was twice as common in valve procedures as in coronary artery revascularization procedures. Impairment of renal function proved reversible only in those patients who survived. After restoration of renal function the prognosis was good.
1980年至1984年间，对1686例成年患者实施了心脏直视手术。这些患者采用体外循环程序（CPB）进行手术。15例患者在CPB后发生急性肾衰竭（ARF），即ARF的发生率为0.9%。所有这些患者均接受了腹膜透析或血液透析治疗。将ARF组术前可能的风险因素与30例未发生并发症的对照组患者（15例连续进行冠状动脉搭桥术和15例连续进行瓣膜修复术）的风险因素进行了比较。年龄、纽约心脏协会（NYHA）分级、射血分数、心腔容积和左心室舒张末期压力不是肾衰竭发生的风险因素。CPB后血小板减少症的发生率在对照组和ARF组之间有统计学显著差异。ARF的死亡率为66.6%。死亡原因是围手术期心肌梗死、感染和胃肠道出血。CPB时间、围手术期事件和术后感染是导致ARF的主要因素。瓣膜手术中肾衰竭的发生率是冠状动脉血运重建手术的两倍。仅在存活的患者中，肾功能损害被证明是可逆的。肾功能恢复后预后良好。
