Kellerman P S
Division of Nephrology, University of California-Davis Medical Center, Sacramento.
Arch Intern Med. 1994 Aug 8;154(15):1674-88.
Due to the hormonal and hemodynamic alterations inherent in the surgical experience, acute renal failure is common during the perioperative period. Acute renal failure occurs in 5% of hospital admissions, and the surgical setting is the second most common cause of inpatient acute renal failure. Because this setting has the highest mortality for acute renal failure, recognition of high-risk patients is essential for careful monitoring and prophylactic measures. Patients with chronic renal insufficiency, elderly patients, jaundiced patients, diabetics, and those undergoing cardiac or aortic surgery are at greatest risk for perioperative acute renal failure. Patients with severe chronic renal failure or end-stage renal disease are at significant risk for development of complications during the perioperative period, due both to renal and nonrenal reasons. Hyperkalemia, infections, arrhythmias, and bleeding commonly occur in these patients during the perioperative period. This population has a reasonable surgical mortality for both general and cardiac surgery, but the extremely high morbidity warrants careful perioperative monitoring and care.
由于手术过程中固有的激素和血流动力学改变，急性肾衰竭在围手术期很常见。急性肾衰竭发生于5%的住院患者中，而手术环境是住院患者急性肾衰竭的第二大常见原因。由于这种情况下急性肾衰竭的死亡率最高，识别高危患者对于仔细监测和采取预防措施至关重要。慢性肾功能不全患者、老年患者、黄疸患者、糖尿病患者以及接受心脏或主动脉手术的患者围手术期急性肾衰竭风险最高。严重慢性肾衰竭或终末期肾病患者由于肾脏和非肾脏原因，在围手术期发生并发症的风险显著增加。高钾血症、感染、心律失常和出血在这些患者围手术期很常见。这一人群接受普通外科和心脏手术均有一定的手术死亡率，但极高的发病率需要围手术期仔细监测和护理。
