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    find Keyword " 腹膜透析" 2 results
    • Mid-term Results of Cardiovascular Surgery Employing Extracorporeal Circulation in Patients Dependent on Dialysis

      Objective To summarize our experience of cardiovascular surgery for patients dependent on dialysis, and evaluate its safety and efficacy.?Methods?Clinical data of 10 consecutive patients dependent on maintenance dialysis underwent cardiovascular operations between Dec. 2004 and April 2011 in Peking Union Medical College Hospital were analyzed retrospectively. There were 6 male and 4 female patients, aged between 23 to 71 (57.6±13.2) years. They were put on dialysis 3-98 (25.2±30.6) months prior to operation due to diabetic nephropathy in 6 patients, chronic glomerulitis in 3 patients and systemic lupus erythemus in 1 patient, and 8 were dependent on hemodialysis and 2 on peritoneal dialysis. Five patients underwent coronary artery bypass grafting, one underwent Bentall procedure,two underwent aortic valve replacement, one underwent mitral valve replacement, and one underwent superior vena cava thrombectomy and patch repair. Patients underwent dialysis on the day before elective operation, followed by continuous ultra-filtration during cardiopulmonary bypass, and then bedside heparin-free continuous veno-venous hyperfiltration-dialysis started 5-32 hours after the operation. Conventional peritoneal dialysis or hemodialysis was resumed 4-7 days after operation.?Results?All operations were successfully completed. Cardiopulmonary bypass time was (125.8±33.5)minutes, aortic clamp time was(77.2±25.5) minutes. One in-hospital death occurred due to septic shock after deep chest wound infection. One patient underwent re-exploration due to pericardial temponade to achieve hemostasis. Three patients experienced atrial fibrillation and were all converted to sinus rhythm by amiodarone. Nine patients recovered to discharge and were followed-up for 8-76 months. Two late deaths occurred due to intracranial hemorrhage and liver carcinoma respectively. Seven survived patients were all in New York Heart Association grade II functional class, and none of them experience major advertent cardiac events related to grafts or prosthetic valve. One patient switched to hemodialysis 14 months after discharge due to peritonitis.Conclusion?Cardiovascular surgery can be practiced in patients dependent on maintenance hemodialysis or peritoneal dialysis with appropriate peri-operative management, so that symptoms can be relieved and quality of life improved.

      Release date:2016-08-30 05:50 Export PDF Favorites Scan
    • 成人心內直視手術后急性腎功能衰竭的治療

      目的 探討體外循環心臟手術后發生急性腎功能衰竭的治療方法及療效。 方法 回顧性分析2011年1月至2012年7月福建醫科大學附屬協和醫院33例行體外循環心臟手術后發生急性腎功能衰竭患者的臨床資料,其中男21例,女12例;年齡25~67 (45.21±7.27) 歲。28例采用床旁連續腎臟替代療法治療,5例采用腹膜透析聯合間歇床旁連續腎臟替代療法治療。對比分析經兩種治療方法患者治療前、后的尿量、尿素氮、血肌酐、血鉀和平均動脈壓的變化。 結果 33例患者經床旁連續腎臟替代療法或腹膜透析聯合間歇床旁連續腎臟替代療法治療后血鉀、血肌酐和尿素氮較治療前明顯降低,平均動脈壓治療6 h后較治療前升高(P<0.05)。圍術期死亡9例,死亡率為27.27%,主要死亡原因為多器官功能衰竭、重癥肺部感染合并氣道出血、惡性心律失常和消化道出血等。24例患者于治療后5~14 d尿量恢復正常,腎功能指標正常。隨訪24例,隨訪3個月,復查腎功能各項指標均正常。 結論 床旁連續腎臟替代療法治療心臟手術后急性腎功能衰竭可獲得滿意的治療效果,但應監測電解質及出凝血情況。對有出血傾向及血小板減少癥患者采用腹膜透析聯合間歇床旁連續腎臟替代治療,也可獲得良好的療效。

      Release date:2016-08-30 05:46 Export PDF Favorites Scan
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  • 松坂南