婴幼儿心脏术后急性肾衰竭腹膜透析的护理

对12例心脏术后急性肾衰竭婴幼儿行腹膜透析治疗，结果9例肾功能完全恢复正常，3例死于心功能衰竭。提出保持透析管路通畅，准确记录出入量，做好婴幼儿保暖、透析液体保温及病情观察是护理的关键。     

婴幼儿心脏术后急性肾衰竭腹膜透析的护理

对12例心脏术后急性肾衰竭婴幼儿行腹膜透析治疗,结果9例肾功能完全恢复正常,3例死于心功能衰竭.提出保持透析管路通畅,准确记录出入量,做好婴幼儿保暖、透析液体保温及病情观察是护理的关键.     

体外循环后并发急性肾衰竭死亡一例

患者 ,男 ,6月 ,6 8kg。因咳嗽发热 3d、当地医院就诊发现心脏杂音转入我院。查体发现胸骨左缘 3～ 4肋间听诊可闻及Ⅱ /Ⅵ收缩期返流样杂音 ,心界扩大。心导管检查示室缺 9 2mm ,房缺 3 8mm ,动脉导管未闭 1mm ,肺动脉高压 ,肺动脉平均压为 4 2mmHg ,肺血管阻力 /体循环阻力为 1∶1 5 ,肺循环血流量 /体循环血流量 1∶1。拟在体外循环下行多发畸形矫治术。术前血红蛋白 1 30 g/L ,血小板 1 98×1 0 9/L ,全身肝素化 ,激活全血凝固时间 (ACT)达到 4 80s行体外循环。人工心肺机为Sarns 80 0 0 ,膜肺为索林公司的Dideco90 1D型 ,转流中 …     

2例心脏术后急性肾衰竭血液滤过的护理

对2例心脏术后急性肾衰竭应用血液滤过技术治疗,密切观察病人生命体征、肾功能、消化道及全身出血倾向,配合强心、利尿、抗凝等治疗,临床效果良好.提示有效护理是心脏术后急性肾衰竭血液滤过治疗的重要保证.     

体外循环术后并发乳糜胸的护理体会

体外循环术后并发乳糜胸是一种少见的严重并发症,据文献报告发生率为0.2～0.5％,我院自1980年6月～1986年12月共行体外循环心内直视手术96例,其中2例并发乳糜胸(发生率2％)。由于及时诊断,合理治疗和良好的护理,2例乳糜胸均已治愈。现将临床监护观察和护理体会介绍如下。病例简介例1:男性,8岁,诊断为先天性心脏病,法乐氏四联症。于1983年3月28日在全身中度低温,     

心脏瓣膜置换术后急性肾衰竭的临床分析

目的:探讨心脏瓣膜置换术后发生急性肾衰竭(ARF)的危险因素.方法:收集1997年1月～2003年12月共547例行心脏瓣膜手术的原始病历资料,进行ARF的危险因素分析.结果:547例中有48例发生ARF(9%),其中3例需要血液透析治疗(ARF-D),与术后肾功能正常组相比,发生ARF的危险因素依次为:体外循环时间、低心输出量综合征(低血压)、多瓣膜置换、术前心功能差、急诊手术、术前肾衰竭及病程长等;发生ARF后病死率明显增加,本组ARF的病死率为4.2%,ARF-D则高达66.7%.结论:急性肾衰竭是心脏瓣膜置换手术的重要并发症之一,避免或减少这些危险因素,可望提高患者的生存率.     

心脏外伤急诊体外循环下心脏修补术的手术配合

对10例心脏外伤急诊手术病人在体外循环直视下行心脏修补术,同时予抗休克处理,结果全部病人均抢救成功.认为手术室护士做好抗休克及手术的准备与配合,对抢救成功有重要作用.     

心脏术后急性肾功能衰竭

急性肾功能是心脏术后常见而严重的并发症，是患者死亡率增加的独立危险因素，探讨心脏术后发生ARF的危险因素，并积极预防和治疗是近年来研究的热点之一，本文就心脏术后发生急性肾功能衰竭的相关因素、治疗和预后等问题的临床研究进展作一综述。     

连续性静脉—静脉血液透析治疗体外循环心脏直视术后急性肾损伤

目的：探讨连续性静脉-静脉血液透析（CVVHD）治疗体外循环心脏直视术后急性肾损伤（acute kidney injury,AKI）的治疗作用。方法：回顾性分析2007年01月～2011年01月15例体外循环心内直视术后AKI的患者采用CVVHD治疗的临床资料。结果：13例存活,2例死亡。存活患者的心率、平均动脉压、动脉氧分压、中心静脉压在CVVHD过程中波动于正常范围,血肌酐、尿素氮、血钾水平在治疗后显著下降,肾功能恢复正常。结论：CVVHD是救治体外循环心脏直视术后AKI患者的有效手段,仍需病例的积累进一步研究。     

综合性护理干预对体外循环心脏手术后ICU综合征的预防效果

目的探讨综合性护理干预对体外循环心脏手术后ICU综合征的预防效果。方法随机将84例行体外循环心脏手术患者分为2组,每组42例。对照组进行常规护理,观察组在常规护理基础上实施综合护理。比较2组患者ICU综合征的发生率。结果观察组ICU综合征发生率低于对照组,差异有统计学意义(P0.05)。结论对行体外循环心脏手术患者实施综合护理干预,能有效降低ICU综合征的发生率。     

Cardiac surgery with cardiopulmonary bypass in patients with chronic renal failure.

OBJECTIVE: Renal failure is known to increase the morbidity and mortality in patients undergoing cardiac surgery. The results of heart surgery in patients with non-dialysis-dependent, mild renal insufficiency are not clear. METHODS: One hundred nineteen adult patients with chronic renal failure underwent cardiac surgery. Group I consisted of 93 patients who had creatinine levels between 1.6 and 2.5 mg/dL but who were not supported by dialysis. Group II consisted of 18 patients with creatinine levels higher than 2.5 mg/dL who were not supported by dialysis. Group III consisted of 8 patients with end-stage renal disease who were receiving hemodialysis. RESULTS: The hospital mortality rates were 11.8%, 33.0%, and 12.5%, respectively. Morbidity was 21.5%, 44.4%, and 75.0%, respectively, in groups I, II, and III. Postoperative hemodialysis was needed in 2 (2.15%) patients from group I and 6 (33%) patients from group II. On multivariable logistic regression analysis, risk factors for mortality were preoperative creatinine level more than 2.5 mg/dL, angina class III-IV, emergency operation, excessive mediastinal hemorrhage, postoperative pulmonary insufficiency, low cardiac output, and rhythm disturbances. Risk factors for morbidity were preoperative creatinine level more than 2.5 mg/dL and postoperative dialysis. CONCLUSIONS: Chronic renal failure increases the mortality and morbidity in patients undergoing cardiac surgery. Renal insufficiency with creatinine levels higher than 2.5 mg/dL increases the risk of postoperative dialysis and prolongs the length of hospital stay. Careful preoperative management and intraoperative techniques, such as avoiding low perfusion pressure and using low-dose dopamine, may be useful for a good operative outcome.     

大面积烧伤并发急性肾衰竭多尿期患者的护理

目的探讨烧伤合并急性肾衰竭多尿期患者的护理对策,提高治愈率。方法对36例大面积烧伤并发急性肾衰竭的患者给予对症治疗和系统护理。结果 36例中治愈33例(91.67%),住院时间47~89(54.0±3.6)d出院;3例死亡(2例死于严重全身感染,1例死于多脏器衰竭)。结论在及时透析、中西医结合治疗的基础上,对大面积烧伤并发肾衰竭的患者给予创面封闭、全面营养支持、对症护理是成功救治患者的关键因素。     

Continuous haemodiafiltration during and after cardiopulmonary bypass in renal failure patients

Purpose

Continuous haemodiafiltration (CHDF) is a technique enhancing the efficiency of solute clearance of continuous haemofiltration by infusing dialysis fluid through the haemofilter. It has been reported to control water and electrolyte balance continuously without haemodynamic instability in critically ill patients with renal failure. Therefore, we used CHDF during and after cardiopulmonary bypass (CPB) in two renal failure patients, and discuss its efficacy.

Clinical features

The first patient undergoing aortic valve replacement had dialysis-dependent renal failure. Chronic renal failure in the second patient undergoing mitral valve replacement and coronary revasculanzation was controlled preoperatively with diuretics. In both cases, CHDF was performed not only during CPB but also in the post-CPB period. Serum concentrations of potassium, urea and creatmine were well-controlled in spite of large amount of blood transfused in the post-CPB penod (1000 ml fresh blood and 400 ml fresh frozen plasma in the fist patient, and 1400 ml fresh blood in the second patient). There was no difficulty in haemostasis dunng the use of nafamostat mesilate as an anticoagulant to keep activated clotting time at about 150 sec for CHDF in the post-CPB period.

Conclusion

Our initial expenences of CHDF dunng and after CPB suggest that the technique provides excellent electrolyte, metabolite and fluid management for the cardiac patients with chronic renal failure. Combined with nafarnostat mesilate for anticoagulation, CHDF was simple and safe and did not increase the nsk of bleeding.     

The association of lowest hematocrit during cardiopulmonary bypass with acute renal injury after coronary artery bypass surgery

BACKGROUND: Acute renal injury is a common serious complication of cardiac surgery. Moderate hemodilution is thought to reduce the risk of kidney injury but the current practice of extreme hemodilution (target hematocrit 22% to 24%) during cardiopulmonary bypass (CPB) has been linked to adverse outcomes after cardiac surgery. Therefore we tested the hypothesis that lowest hematocrit during CPB is independently associated with acute renal injury after cardiac surgery. METHODS: Demographic, perioperative, and laboratory data were gathered for 1,404 primary elective coronary bypass surgery patients. Preoperative and daily postoperative creatinine values were measured until hospital discharge per institutional protocol. Stepwise multivariable linear regression analysis was performed to determine whether lowest hematocrit during CPB was independently associated with peak fractional change in creatinine (defined as the difference between the preoperative and peak postoperative creatinine represented as a percentage of the preoperative value). A p value of less than 0.05 was considered significant. RESULTS: Multivariable analyses including preoperative hematocrit and other perioperative variables revealed that lowest hematocrit during CPB demonstrated a significant interaction with body weight and was highly associated with peak fractional change in serum creatinine (parameter estimate [PE] = 4.5; p = 0.008) and also with highest postoperative creatinine value (PE = 0.06; p = 0.004). Although other renal risk factors were significant covariates in both models, TM50 (an index of hypotension during CPB) was notably absent. CONCLUSIONS: These results add to concerns that current CPB management guidelines accepting extreme hemodilution may contribute to postoperative acute renal and other organ injury after cardiac surgery.     

Risks of acute renal failure after cardiopulmonary bypass surgery in children: a retrospective 10-year case-control study

To our knowledge there are no case-control studies that haveexamined the main risk factors for acute renal failure (ARF)following cardiopulmonary bypass surgery in children. We thereforeevaluated the potential risk factors in a large retrospectivecase-control study. Sixty-one of 2262 children (2.7%) developedpostcardiopulmonary bypass surgery ARF requiring peritonealdialysis (PD) from 1982 to 1991. Fifty-eight of 61 cases (medianage 8.5 months) were selected by systematic sampling and matchedwith 176 controls who did not develop ARF. The four matchingvariables were age, cardiopulmonary bypass and circulatory arrestduration, and year of operation. Mortality rate was 79% in cases (controls: 18%). Forty-threeof 48 of the deceased cases did not recover renal function;no renal cause of death was found; 13 of 61 cases survived andrecovered renal function. Multiple regression analysis showedthe following significant risk factors for postcardiopulmonarybypass surgery ARF: central venous hypertension >12 h (oddsratio (OR) 9.6); systolic arterial hypotension >12 h (OR8.9); dopamine dosage >15 µg/kg/min (OR 3.0); adrenaline(OR 5.9) and isoproterenol (OR 13.5) use. High preoperativeserum creatinine, cyanosis, and vasodilator use were not significantrisk factors. We conclude that: (1) haemodynamic alterations were the maincause of postcardiopulmonary bypass surgery ARF; (2) ARF wasassociated with but was not the cause of the high mortalityrate; (3) the risk of ARF increased almost 10-fold after 12h of central venous hypertension and/or of systolic arterialhypotension; (4) effective dosages of inotropes might have beena risk factor for ARF; (5) a slight precardiopulmonary bypasssurgery reduction of renal function alone did not representan increased risk for ARF.     

非体外循环冠脉旁路移植术后心肺功能衰竭患者ECMO治疗与护理

对6例非体外循环冠脉旁路移植术后心肺功能衰竭患者行ECMO救治。经过精心治疗及护理,4例患者救治成功;1例患者于ECMO运行96 h,突发结性心律,家属放弃治疗;1例患者ECMO运行132 h,并发多器官功能衰竭,于术后15 d死亡。提出在给予该组患者保护性隔离的基础上,密切观察病情变化,做好应用ECMO治疗时容量、流量及凝血等方面的监测,做好呼吸系统及各种管路的管理,可以减少感染等并发症的发生,改善患者预后。     

Anemia-associated acute kidney injury after cardiac surgery with cardiopulmonary bypass

Objective To investigate the incidence and to evaluate the risk factors of acute kidney injury (AKI) following cardiac surgery with cardiopulmonary bypass (CPB) at general hospitals. Methods A retrospective cohort database study was conducted, involving 233 patients who were scheduled to heart valve surgery or coronary artery bypass grafting (CABG) with CPB technique. Logistic regression was used to screen out the risk factors of AKI after the surgery. Results The study population, with an average age of 57±12 years (age 21 to 83) were investigated, there were 54(23.2%) diabetes patients, 105 (45.1%) hypertension patients, 21 (9%) chronic kidney disease (CKD) patients, and 51 (21.9%) anemia patients. Overall incidence of AKI was 32.2%. The Analysis Result indicates that preoperative CKD, anemia, hypoalbuminemia, left ventricular ejection fraction, intraoperative aortic block time, minimum mean arterial pressure, perioperative infection, and application of vancomycin are risk factors associated with postoperative AKI. Multiariable Logistic regression suggests that basic CKD (OR=9.498, P=0.001), anemia (OR=3.150, P=0.021), the LVEF before surgery (OR=1.733, P=0.045), intraoperative aortic block time (OR=2.227, P=0.026), and white blood cell (OR=3.357, P=0.032) were the independent risk factors of AKI. Conclusions AKI is a common complication following cardiac surgery with CPB. The patients with preoperative renal insufficiency, anemia, long intraoperative aortic block time and higher perioperative white blood cell count are subjected to a higher incidence of AKI. Alleviating patients’ anemia and reducing artery block of extracorporeal circulation time therefore might be potential means to mitigate the risks of AKI after cardiac surgery.     

Cardiac surgery with cardiopulmonary bypass in patients with type II heparin-induced thrombocytopenia

BACKGROUND: The use of cardiopulmonary bypass (CPB) in patients with a history of type II heparin-induced thrombocytopenia (HIT) may be associated with complications related to their anticoagulation management. METHODS: Between January 1997 and December 1999, among 4,850 adults patients who underwent cardiac surgery in our institution, 10 patients presented with preoperative type II HIT. In 4 patients, anticoagulation during CPB was achieved with danaparoid sodium. In 6 other patients, heparin sodium was used after pretreatment with epoprostenol sodium. RESULTS: No significant change in platelet count occurred in any patient. No intraoperative thrombotic complication was encountered. Total postoperative chest drainage ranged from 250 to 1,100 ml in patients pretreated with epoprostenol and 1,700 to 2,470 ml in patients who received danaparoid sodium during CPB (p < 0.05, Mann-Whitney U test). CONCLUSIONS: During CPB, inhibition of platelet aggregation by prostacyclin may be a safe anticoagulation approach in patients with type II HIT.