透析患者的冠状动脉搭桥手术。
Coronary artery bypass graft surgery in dialysis patients.
作者信息
Jahangiri M, Wright J, Edmondson S, Magee P
机构信息
Department of Cardiac Surgery, London Chest Hospital, UK.
出版信息
Heart. 1997 Oct;78(4):343-5. doi: 10.1136/hrt.78.4.343.
OBJECTIVE
To examine the short term results and long term survival of patients on long term dialysis undergoing coronary artery bypass graft surgery.
METHODS
A retrospective analysis of 19 patients on established dialysis who underwent coronary revascularisation between 1983 and 1995; 14 patients (73%) had class IV angina and five (25%) had unstable angina requiring heparin and nitrate infusions before surgery.
RESULTS
The 30 day mortality was 5%. Follow up was completed in the remaining 18 patients. The mean follow up time was 34 months (range eight to 61). During the follow up period four patients died of cardiac causes. The actuarial survival at one, two, and three years was 87%, 78%, and 59%, respectively. The overall functional status was significantly improved compared to preoperative levels, with a mean Karnofsky score of 76% (p < 0.01) at three years.
CONCLUSIONS
Coronary artery bypass graft surgery can be performed with increased but acceptable morbidity and mortality in chronic dialysis patients. It results in considerable improvement in symptoms and functional status. However, long term survival is limited and this requires further investigation.
目的
研究长期透析患者接受冠状动脉搭桥手术的短期结果和长期生存率。
方法
对1983年至1995年间19例已接受透析的患者进行冠状动脉血运重建的回顾性分析；14例（73%）患者有IV级心绞痛，5例（25%）有不稳定型心绞痛，术前需要静脉输注肝素和硝酸盐。
结果
30天死亡率为5%。其余18例患者完成随访。平均随访时间为34个月（8至61个月）。随访期间，4例患者死于心脏原因。1年、2年和3年的精算生存率分别为87%、78%和59%。与术前水平相比，总体功能状态有显著改善，3年时卡诺夫斯基评分平均为76%（p<0.01）。
结论
慢性透析患者进行冠状动脉搭桥手术时，发病率和死亡率虽有所增加但仍可接受。该手术可使症状和功能状态得到显著改善。然而，长期生存率有限，这需要进一步研究。
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