Landes R G, Lillehei R C, Lindsay W G, Nicoloff D M
Ann Thorac Surg. 1976 Jul;22(1):41-3. doi: 10.1016/s0003-4975(10)63950-1.
The predictive value of free-water clearance measurements for the early recognition of acute renal insufficiency was evaluated in 59 patients immediately following cardiopulmonary bypass. Blood urea nitrogen and serum creatinine measurements were taken before and after operation. Intraoperatively, immediately after completion of bypass, urine and serum samples were obtained for osmolality. Duration of bypass, urine output, degree of hemolysis, and quality of perfusion were recorded. Fifty-four patients developed no signs of renal insufficiency following bypass, and all had free-water clearance values equal to or less than -20 ml per hour. Five patients who had free-water clearance values equal to greater than -8 ml per hour developed manifestations of an acute renal insufficiency state. There were no false-negative or false-positive determinations. Consequently, free-water clearance measurements appear to be a reliable indicator of those patients who will develop renal insufficiency following cardiopulmonary bypass. Early recognition provides an opportunity immediately after operation for initiating treatment consisting of administration of diuretics, potassium restriction, and oliguric fluid regimens.
对59例体外循环术后患者评估了自由水清除率测量对急性肾功能不全早期识别的预测价值。术前及术后均测定血尿素氮和血清肌酐。术中，体外循环结束后立即采集尿液和血清样本测定渗透压。记录体外循环时间、尿量、溶血程度和灌注质量。54例患者体外循环后未出现肾功能不全迹象，且所有患者的自由水清除率值均等于或小于每小时-20毫升。5例自由水清除率值大于-8毫升/小时的患者出现急性肾功能不全状态的表现。无假阴性或假阳性判断。因此，自由水清除率测量似乎是体外循环后将发生肾功能不全患者的可靠指标。早期识别为术后立即开始包括使用利尿剂、限制钾摄入和少尿期液体治疗方案的治疗提供了机会。
