Nakano H, Shimakura T, Katsumata T, Shimamura Y, Yabuki A, Matsuda N, Yamaguchi T, Kawakami A, Ihashi K, Sakamoto T
Department of Cardiovascular Surgery, Fukuyama Cardiovascular Hospital, Japan.
Kyobu Geka. 1993 Mar;46(3):241-6.
Four dialysis patients received aorto-coronary bypass grafting (CABG) at Fukuyama cardiovascular hospital from April 1989 to March 1992. We employed continuous ambulatory peritoneal dialysis (CAPD) in two cases, hemodialysis with extracorporeal ultrafiltration method (ECUM + HD) in one case and hemodiafiltration with continuous veno-venous hemofiltration (CVVHF + HDF) in one case for perioperative management. In each cases, intermittent HD was undergone during 4 days before operation. Intraoperatively, HD was used together with extracorporeal circulation. Blood pressure in the postoperative course changed more frequently in CAPD cases than ECUM + HD or CVVHF + HDF case. Especially, CVVHF + HDF stabilized the movement of circulation and kept balance of serum BUN, Cr after the operation (BUN; 27.2 +/- 6.3, Cr; 5.0 +/- 0.6). We concluded that CVVHF + HDF would be the most favorable method to maintain the fluid balance stably for the uremic patients after CABG.
1989年4月至1992年3月期间，四名透析患者在福山心血管医院接受了冠状动脉搭桥术（CABG）。我们对两例患者采用持续非卧床腹膜透析（CAPD），一例采用体外超滤法血液透析（ECUM + HD），一例采用持续静脉-静脉血液滤过血液透析滤过（CVVHF + HDF）进行围手术期管理。在每例患者中，术前4天进行间歇性血液透析。术中，血液透析与体外循环同时使用。术后过程中，CAPD病例的血压变化比ECUM + HD或CVVHF + HDF病例更频繁。特别是，CVVHF + HDF稳定了循环的运行，并在术后保持了血清尿素氮、肌酐的平衡（尿素氮；27.2 +/- 6.3，肌酐；5.0 +/- 0.6）。我们得出结论，CVVHF + HDF是冠状动脉搭桥术后尿毒症患者稳定维持液体平衡的最有利方法。
