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[透析患者冠状动脉搭桥手术的结果]

[Results of coronary artery bypass grafting in dialysis patients].

作者信息

Kobayashi J, Sasako Y, Kosakai Y, Isobe F, Nakano K, Eishi K, Kito Y, Kawashima Y

机构信息

Department of Cardiovascular Surgery, National Cardiovascular Center, Osaka, Japan.

出版信息

Nihon Kyobu Geka Gakkai Zasshi. 1995 Sep;43(9):1625-30.

PMID:8530848
Abstract

To determine the short- and medium-term results of coronary artery bypass grafting (CABG) in dialysis patients, we analyzed a group of 14 patients with chronic renal failure who underwent CABG between May 1990 and October 1994. Two patients had concomitant valve repair for mitral regurgitation. Hospital mortality was 14% (2 out of 14). These two patients died of ileus due to ischemic colitis and agranulocytosis respectively. There was one late death from stroke. The four significant postoperative complications (morbidity 29%) were composed of two sternal dehiscence, one cardiac tamponade because of bleeding, and one perioperative myocardial infarction. Graft patency rate was 97% (34 out of 35 in 13 patients) within one month. Actuarial survival was 86% at one 1 to 3 years, and 43% at 3 and a half years. This rate is not significantly different from all dialysis patients, but night be better than dialysis patients with coronary artery disease who had not undergone CABG in the previous reports. Left ventricular size is larger in patients who died or who had significant complications in hospital than in patients with uneventful postoperative course. Cardiac arrest time, cardiopulmonary bypass time, chest tube output, and the amount of transfusion might be also related to mortality and morbidity though statistically not significant.

摘要

为了确定透析患者冠状动脉旁路移植术(CABG)的短期和中期结果,我们分析了一组1990年5月至1994年10月期间接受CABG的14例慢性肾衰竭患者。2例患者同时进行了二尖瓣反流瓣膜修复术。医院死亡率为14%(14例中的2例)。这2例患者分别死于缺血性结肠炎引起的肠梗阻和粒细胞缺乏症。有1例患者后期死于中风。4例严重术后并发症(发病率29%)包括2例胸骨裂开、1例因出血导致的心包填塞和1例围手术期心肌梗死。13例患者中35处移植物在1个月内的通畅率为97%(34处)。1至3年的精算生存率为86%,3年半时为43%。该比率与所有透析患者无显著差异,但可能优于既往报告中未接受CABG的冠心病透析患者。死亡或住院期间出现严重并发症的患者左心室大小比术后病程平稳的患者更大。心脏骤停时间、体外循环时间、胸管引流量和输血量可能也与死亡率和发病率有关,尽管在统计学上不显著。

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