中国血液净化

中国血液净化 ›› 2021, Vol. 20 ›› Issue (07): 449-454.doi: 10.3969/j.issn.1671-4091.2021.07.005

• 临床研究 • 上一篇    下一篇

血液透析降低严重肾功能不全患者心脏外科手术后30 天死亡率

王国勤1,谢晓东1,程虹1,董然2,卞维静1,叶楠1   

  1. 首都医科大学附属北京安贞医院1肾内科2心脏外科
  • 收稿日期:2021-02-25 修回日期:2021-05-19 出版日期:2021-07-12 发布日期:2021-07-21
  • 通讯作者: 程虹 drchengh@163.com E-mail:wangguoqin1@163.com
  • 基金资助:
    首都卫生发展科研专项（2011-2006-07/2018-2-1051），北京市医管局“培育”项目（PX2019022）

Pre- operativemaintenance hemodialysis reduced the 30-day mortality of severe renal dysfunction patients after cardiac surgery

  1. 1Department of Nephrology and 2Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 10029, China
  • Received:2021-02-25 Revised:2021-05-19 Online:2021-07-12 Published:2021-07-21
  • Contact: Guo qinWang E-mail:wangguoqin1@163.com

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摘要： 【摘要】目的探讨严重肾功能不全患者手术前规律血液透析与心脏外科手术后30 天内死亡的关系。方法收集2010 年1 月～2020 年10 月在北京安贞医院接受心脏外科手术且术前估算肾小球滤过率(eGFR)＜30ml/(min·1.73m2)患者的围手术期临床资料，分析手术前规律血液透析对手术后30 天内死亡率的影响。结果共272 例患者纳入研究，男性73.2%，平均年龄(61.4±9.5)岁，手术前进行规律透析的患者85 名(31.3%)，手术后30 天总体死亡率为16.9%。COX 回归分析显示手术前进入维持性血液透析治疗(maintenance hemodialysis, MHD)(HR:0.399, 95% CI：0.160～0.996, P=0.049)降低患者手术后30 天的死亡风险。手术后实施二次开胸手术(HR: 4.287, 95% CI：1.717～10.705, P=0.002)、手术后左心室射血分数(left ventricular ejection fraction, LVEF)＜40%(HR：3.251, 95% CI:1.581～6.685, P=0.001)、手术中出血量大(HR:1.133, 95% CI:1.033～1.242, P=0.008)及手术后呼吸机使用时间长(HR:1.457, 95% CI:1.230～0.909, P=0.024)是严重肾功能不全患者手术后30 天死亡风险增加的影响因素；男性患者(HR:0.457, 95% CI: 0.230～0.909, P=0.024)死亡风险低。结论严重肾功能不全患者接受心脏外科手术的早期死亡风险较高，手术前进行充分的MHD可以降低手术后30 天死亡风险。

关键词: 维持性血液透析, 严重肾功能不全, 心脏外科手术, 手术后30 天死亡率

Abstract: 【Abstract】Objectives Patients with severe renal dysfunction undergoing cardiac surgery still are associated with many complications and higher mortality. The present study aimed to investigate the relationship between prEoperative maintenance hemodialysis (MHD) and 30-day mortality after cardiac surgery in patients with estimated glomerular filtration rate (eGFR) <30ml/min/1.73m2. Methods A total of 272 severe renal dysfunction patients undergoing cardiac surgery during the period between Jan. 2010 and Oct. 2020 were retrospectively studied. Multivariate COX proportional hazard was used to estimate hazard ratio (HR) and 95% confidence interval (CI) of the risk for 30-day mortality after the surgery. Results In the 272 severe renal
dysfunction patients undergoing cardiac surgery, 73.2% were male, the average age was 61.4±9.5years, 85 patients (31.3%) had regular MHD before the surgery, and their 30-days mortality after the surgery was 16.9%. COX regression analyses showed that prEoperative MHD reduced the 30-day mortality (HR=0.399, 95% CI 0.160～0.996, P=0.049), and that rEoperation (HR=4.287, 95% CI 1.717～10.705, P=0.002), lower post-operative left ventricular ejection fraction (LVEF<40%) (HR=3.251, 95% CI 1.581～6.685, P=0.001), more intraoperative blood loss (HR=1.133, 95% CI 1.033～1.242, P=0.008), and longer post-operative ventilator time (HR=1.457, 95% CI 1.230～0.909, P=0.024) were the risk factors for higher 30-day mortality, but male patients (HR= 0.457, 95% CI 0.230～0.909, P=0.024) had a lower risk of mortality. Conclusions Patients with severe renal dysfunction undergoing cardiac surgery were associated with many complications and higher mortality. PrEoperative MHD before cardiac surgery reduced the 30-day mortality.

Key words: Maintenance hemodialysis, Severe renal dysfunction, Cardiac surgery, 30-day mortality

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