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目的总结合并慢性肾功能不全的冠心病患者行冠状动脉旁路移植术(CABG)的临床经验。方法1997年4月至2004年11月,对18例合并慢性肾功能不全[术前血清肌酐(C r)129~497μm o l/L(216.0±98.3μm o l/L)]的冠心病患者行CABG,其中体外循环CABG和非体外循环CABG各9例。结果术后住院死亡3例,其中大面积脑梗死、肾功能衰竭1例;肾脏和呼吸功能衰竭1例;肺部感染、呼吸功能衰竭1例。4例患者采用腹膜或血液透析。随访11例,失访4例,随访时间2~22个月(7.6±7.3个月),随访期间无明显的心绞痛发作5例,心绞痛较术前明显减轻5例,有较剧烈的胸痛发作1例。血清C r较术前变化不明显4例(变化<50μm o l/L),较术前明显增高(C r增高>100μm o l/L)5例。长期腹膜透析1例,脑出血1例,死亡2例(脑梗死、肺部感染);抗凝治疗发生并发症1例。结论对合并肾功能不全的冠心病患者积极改善肾功能,通过适当的围术期处理,行CABG后的近期结果是可以接受的。
Objective To summarize the clinical experience of coronary artery bypass grafting (CABG) in patients with coronary heart disease complicated with chronic renal insufficiency. Methods From April 1997 to November 2004, 18 CABG patients with coronary heart disease complicated with chronic renal failure [preoperative serum creatinine (129 ~ 497 μmol / L)] (216.0 ± 98.3 μmol / L) , Of which 9 cases of CABG and 9 cases of non-cardiopulmonary bypass CABG. Results There were 3 hospitalizations after hospitalization, including large area cerebral infarction, renal failure in 1 case, kidney and respiratory failure in 1 case, pulmonary infection and respiratory failure in 1 case. Four patients underwent peritoneal or hemodialysis. Eleven cases were followed up and 4 cases were lost to follow-up. The follow-up time ranged from 2 to 22 months (7.6 ± 7.3 months). No significant angina pectoris occurred in 5 cases during follow-up. Angina pectoris was significantly relieved in 5 cases example. Serum C r was not significantly different from preoperative 4 cases (change <50μm o l / L), significantly higher than preoperative (C r increased> 100μm o / L) in 5 cases. Long-term peritoneal dialysis in 1 case, 1 case of cerebral hemorrhage, 2 cases of death (cerebral infarction, lung infection); 1 case of complications of anticoagulant therapy. Conclusions Coronary heart disease patients with renal insufficiency can improve renal function. With proper perioperative management, recent results after CABG are acceptable.