Hilberman M, Myers B D, Carrie B J, Derby G, Jamison R L, Stinson E B
J Thorac Cardiovasc Surg. 1979 Jun;77(6):880-8.
In a prospective 6 month study of 204 patients requiring cardiac operations, five (2.5 percent) developed acute renal failure (ARF) and five (2.5 percent) had documented renal dysfunction (RD). Preoperative left ventricular dysfunction and prolonged cardiopulmonary bypass (CPB) were important predictors of subsequent RD/ARF; CPB pressure per se was not. Physiological and clinical studies in 51 selected patients studied over an 18 month period documented the effectiveness of low flow, low pressure CPB in preserving postoperative renal function. Twenty-two patients with nonazotemic postoperative courses demonstrated moderate depression of cardiac function while the glomerular filtration rate (GFR) was normal (98 +/- 30 ml./min/1.73 M.2) within 24 hours of operation. Seventeen high risk patients developed AFF (65 percent mortality rate) and 12 experienced severe RD without ARF (17 percent mortality). ARF (65 percent mortality rate) and 12 experienced severe RD without ARF (17 percent mortality). Eleven patients with ARF and 11 with RD were studied in the early postoperative period; at this time, all 22 patients demonstrated RD with equivalent severe depression of cardiac and renal function. Superposition of further hemodynamic or toxic insults upon ischemic kidneys was usually necessary for ARF to occur.
在一项针对204例需要进行心脏手术患者的为期6个月的前瞻性研究中，5例（2.5%）发生急性肾衰竭（ARF），5例（2.5%）有记录的肾功能障碍（RD）。术前左心室功能障碍和体外循环（CPB）时间延长是随后发生RD/ARF的重要预测因素；CPB压力本身并非如此。在18个月期间对51例选定患者进行的生理和临床研究证明了低流量、低压CPB在保护术后肾功能方面的有效性。22例术后无氮质血症病程的患者在术后24小时内心脏功能有中度降低，而肾小球滤过率（GFR）正常（98±30 ml./min/1.73 M.2）。17例高危患者发生急性肾衰竭（AFF，死亡率65%），12例发生无ARF的严重RD（死亡率17%）。对11例ARF患者和11例RD患者在术后早期进行了研究；此时，所有22例患者均表现为RD，心脏和肾功能均有同等程度的严重降低。ARF的发生通常需要在缺血性肾脏上叠加进一步的血流动力学或毒性损伤。
