Hilberman M, Derby G C, Spencer R J, Stinson E B
J Thorac Cardiovasc Surg. 1980 Jun;79(6):838-44.
Sequential pathophysiological data were analyzed from 14 patients who exhibited similar severe depression of cardiac and renal function within 24 hours of cardiac operation. Seven patients exhibited postoperative renal dysfunction (defined by a minimum postoperative clearance of inulin [Cin] between 20 ml/min/1.73 m2 and one-half normal) and seven progressed from renal dysfunction to acute renal failure (ARF) (Cin less than or equal to ml/min/1.73 m2). In ARF patients depression of cardiac function was profound and persistent from postoperative days 1 to 7. Urine flow remained greater than 1 ml/min, and serum creatinine rose progressively. The Cin declined progressively during the first postoperative week. The ratio or urinary to plasma osmolality fell, and the fractional excretion of sodium (FENa) and potassium (FEK) increased substantially. By contrast, in renal dysfunction patients definite hemodynamic improvement occurred and renal function remained stable. Increased FENa in renal dysfunction was associated with hemodynamic improvement, weight loss, and stable fractional potassium excretion. These data provide unique documentation of the indices of hemodynamic and renal function associated with the progression to postoperative ARF. The central role of sustained profound depression of cardiac function in this progression appears to be the primary factor in the lethality of postoperative ARF.
对14例在心脏手术后24小时内出现类似严重心肾功能不全的患者的序贯病理生理数据进行了分析。7例患者出现术后肾功能不全（定义为术后菊粉清除率[Cin]最低为20 ml/min/1.73 m2且为正常的一半），7例从肾功能不全进展为急性肾衰竭（ARF）（Cin小于或等于ml/min/1.73 m2）。在ARF患者中，术后1至第7天心功能严重且持续受到抑制。尿量维持在大于1 ml/min，血清肌酐逐渐升高。术后第一周内Cin逐渐下降。尿渗透压与血浆渗透压之比下降，钠（FENa）和钾（FEK）的分数排泄大幅增加。相比之下，肾功能不全患者出现了明确的血流动力学改善，肾功能保持稳定。肾功能不全时FENa升高与血流动力学改善、体重减轻及钾分数排泄稳定有关。这些数据提供了与术后ARF进展相关的血流动力学和肾功能指标的独特记录。心功能持续严重抑制在这一进展中的核心作用似乎是术后ARF致死率的主要因素。
