Maccario M, Fumagalli C, Dottori V, Grasso A M, Agostini M, Parodi E, Pergolo A, Spagnolo S, Passerone G
Heart Surgery Anesthesia and Resuscitation Service, S. Martino Hospital, University of Genoa, Italy.
J Cardiovasc Surg (Torino). 1996 Apr;37(2):153-9.
The authors describe 9 cases of rhabdomyolytic acute renal failure (ARF) as a complication of cardiopulmonary bypass.
Retrospective research between June 1992 and March 1994.
Department of Cardiac Surgery.
931 consecutive patients undergoing major cardiac surgery.
Patients affected by rhabdomyolytic ARF were treated with pharmacological therapy and/or plasmapheresis/continuous arteriovenous hemofiltration. In seven patients indirect cannulation of the femoral artery was used.
Incidence, risk factors of syndrome results obtained with pharmacological treatment, CAVH and plasmapheresis were evaluated. Statistical analysis was performed with ANOVA, Tukey Kramer test and chi2 test (p<0.05 as significant).
The syndrome occurred in 0.96% (9/931 patients) of the total cases; 11.3% (6/53 -p<0.0000) in patients undergoing a direct femoral artery cannulation for cardiopulmonary bypass and 9.5% (2/21, p<0.01) in patients in which the aortic balloon pump was used. Six patients develop acute anuric renal failure and underwent plasma exchange and hemodialysis (1 case) or CAVH (5 cases); 3 patients underwent early medical treatment and developed developed acute renal failure (ARF) with preserved diuresis. Early medical therapy appeared to prevent the evolution towards anuric ARF. The indirect cannulation of the femoral artery does not seem to produce a rhabdomyolytic ARF syndrome. In patients with direct femoral artery cannulation risk factors appear to be: arteriopathy (p<0.001), prolonged extra corporeal circulation (p<0.001), low cardiac output syndrome (p<0.001), continuous i.v. infusion of epinephrine (p<0.0001).
Rhabdomyolytic acute renal failure is a severe complication, early identification of patients ¿at risk¿ is most important. The preventive measures and the therapy adopted proved efficient.
作者描述了9例横纹肌溶解型急性肾衰竭（ARF）作为体外循环并发症的病例。
1992年6月至1994年3月间的回顾性研究。
心脏外科。
931例连续接受心脏大手术的患者。
横纹肌溶解型ARF患者接受药物治疗和/或血浆置换/连续性动静脉血液滤过治疗。7例患者采用股动脉间接插管。
评估综合征的发生率、药物治疗、连续性动静脉血液滤过（CAVH）和血浆置换的结果的危险因素。采用方差分析、Tukey Kramer检验和卡方检验进行统计学分析（p<0.05为有统计学意义）。
该综合征在总病例中的发生率为0.96%（9/931例患者）；在接受体外循环股动脉直接插管的患者中为11.3%（6/53，p<0.0000），在使用主动脉球囊泵的患者中为9.5%（2/21，p<0.01）。6例患者发生急性无尿性肾衰竭，接受了血浆置换和血液透析（1例）或连续性动静脉血液滤过（5例）；3例患者接受早期药物治疗，发生了尿量保留的急性肾衰竭（ARF）。早期药物治疗似乎可预防发展为无尿性ARF。股动脉间接插管似乎不会产生横纹肌溶解型ARF综合征。在股动脉直接插管的患者中，危险因素似乎包括：动脉病变（p<0.001）、体外循环时间延长（p<0.001）、低心排血量综合征（p<0.001）、持续静脉输注肾上腺素（p<0.0001）。
横纹肌溶解型急性肾衰竭是一种严重并发症，早期识别“高危”患者至关重要。所采取的预防措施和治疗方法被证明是有效的。
