心脏术后急性肾功能衰竭的临床研究
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摘要
目的急性肾功能衰竭(ARF)是心脏外科手术后常见而严重的并发症之一,如何防治心脏手术后ARF一直备受关注。本研究首先分析体外循环和非体外循环心脏手术后发生的ARF发生率和危险因素,再次分析对ARF的早期诊断以及强化利尿治疗和血液净化治疗的效果,从而减少心脏手术后ARF的发生并降低心脏手术死亡。方法取自1993年1月到2007年12月心脏手术患者的病史资料,共879例,术后发生急性肾功能衰竭45例,其中体外循环组35例,非体外循环组10例,分别随机抽取42例及34例同期心脏手术患者作二组对照病例。分别统计体外循环和非体外循环心脏手术后发生ARF的发生率,并应用多因素回归分析方法进行ARF的危险因素分析。对心脏手术后发生ARF的患者首先进行强化利尿治疗,如果强化利尿治疗效果不佳,则尽快行血液净化治疗(透析,滤过)并观察其疗法。结果心脏手术后ARF的总发生率为5.12%,其中体外循环心脏手术后ARF的发生率为5.07%,非体外循环心脏手术后ARF的发生率为5.29%。心脏手术后ARF的死亡率为11.1%。体外循环心脏手术后ARF的危险因素是男性(P＜0.05)、术前慢性肾功能不全(P＜0.01)、术前高血压(P＜0.05)和术后低血压(P＜0.01)。非体外循环心脏手术后ARF的危险因素是术前慢性肾功能不全(P＜0.05)和术后低血压(P＜0.05)。45例ARF患者在强化利尿治疗后,35例患者(7%)在3-5h后尿量增加,7-35h之间恢复正常。另外10例(23%)尿量没有明显增加而肌酐进行性上升,因此予血液净化治疗(透析,滤过)。其中5例作血透,5例作血滤。透析和滤过治疗后与治疗前各指标相比,两组均有显著性差异。尤其在滤过组,滤过治疗后与治疗前的各指标(平均血压、尿素氮、肌酐、血氧分压)改善有显著性差异。血液净化治疗患者死亡5例,死亡率50%,其中血透组3例,血滤组2例。出院40例ARF患者,经过随访,死亡5例,死亡原因为多脏器功能衰竭。结论术前肾功能不全、术前高血压和术后低血压为心脏手术后ARF的独立危险因素。正确的手术围术期处理对预防急性肾功能衰竭至关重要,及时诊断、术后尽早强化利尿治疗和积极血液净化治疗是抢救心脏手术后ARF成功的关键。
OBJECTIVE Acute renal failure (ARF) is one of the most common and severe complication in patients after cardiac surgery. Therefore how to prevent and successfully treat ARF post cardiac surgery is still a concern of cardiac surgeons. This study analyse the risk factors of ARF in cardiac surgery patient with cardiopulmonary bypass and without cardiopulmonary bypass, to establish early diagnosis and to evaluate the efficacy of diuretic therapy and blood purification therapy, thereby reducing the occurrence of ARF and decreasing the mortality of ARF after cardiac surgery. METHOD During the period of January 1993 to December 2007, 45 cases who had developed ARF from a total of 879 cases following cardiac surgery were taken into study, which were 35 cases with cardiopulmonary bypass and 10 cases without cardiopulmonary bypass. 42 and 34 patients undergoing cardiac surgery at the same period were randomly selected as control case. The occurrence and risk factors of ARF developing after cardiopulmonary bypass and without cardiopulmonary bypass were identified through regression analysis using multi-factor analytical method. The post cardiac surgery ARF 45 cases all went through diuresis treatment. If diuresis has no effect, immediate purification treatment (hemodialysis, hemofiltartion) were undertaken. RESULTS Total ARF occurrence post cardiac surgery was 5.12%, which was 5.07% with cardiopulmonary bypass surgery, and 5.29% without cardiopulmonary bypass surgery. The most important risk factors for those with the use of cardiopulmonary bypass are post surgical hypotension (P<0.001), pre-existing renal dysfunction (P<0.05). Among the 45 cases of ARF after dialysis treatment, 35 cases (77%) had increased urine output after 3-5h, within 7-35h returned to normal, other 10 cases (23%) had no noticeable increase in urine and creatinine continued to increase. Therefore blood purification treatment (dialysis, filtration). Of the 10 cases, 5 cases had hemodialysis, 5 cases had filtration. The clinical situation of pre and post dialysis and filtration treatment in two groups had significiant difference. Especially in filtration groups, pre and post filtration treatment indicators (average blood pressure, urea nitrogen, creatinine, oxygen partial pressure) were significant improved. Among the patients of blood purification treatment, 5cases died the mortality 50%, 3 cases in dialysis, 2 cases in filtration. The main cause of the death was the multi organ failure. 40 cases of the discharged ARF cases underwent visit, 5 cases died, the cause of deaths is multi organ failure. Conculsion Pre-existing hypertension and post surgical hypotension is the independent risk factor of ARF after cardiac surgery. In surgical environment, correct method of disposition is most important in the preventive treatment of the ARF, and urgent diagnosis and early treatments like diuresis and active blood purification are the key factors of successive emergency treatment of post cardiac surgical ARF.
OBJECTIVE Acute renal failure (ARF) is one of the most common and severe complication in patients after cardiac surgery. Therefore how to prevent and successfully treat ARF post cardiac surgery is still a concern of cardiac surgeons. This study analyse the risk factors of ARF in cardiac surgery patient with cardiopulmonary bypass and without cardiopulmonary bypass, to establish early diagnosis and to evaluate the efficacy of diuretic therapy and blood purification therapy, thereby reducing the occurrence of ARF and decreasing the mortality of ARF after cardiac surgery. METHOD During the period of January 1993 to December 2007, 45 cases who had developed ARF from a total of 879 cases following cardiac surgery were taken into study, which were 35 cases with cardiopulmonary bypass and 10 cases without cardiopulmonary bypass. 42 and 34 patients undergoing cardiac surgery at the same period were randomly selected as control case. The occurrence and risk factors of ARF developing after cardiopulmonary bypass and without cardiopulmonary bypass were identified through regression analysis using multi-factor analytical method. The post cardiac surgery ARF 45 cases all went through diuresis treatment. If diuresis has no effect, immediate purification treatment (hemodialysis, hemofiltartion) were undertaken. RESULTS Total ARF occurrence post cardiac surgery was 5.12%, which was 5.07% with cardiopulmonary bypass surgery, and 5.29% without cardiopulmonary bypass surgery. The most important risk factors for those with the use of cardiopulmonary bypass are post surgical hypotension (P<0.001), pre-existing renal dysfunction (P<0.05). Among the 45 cases of ARF after dialysis treatment, 35 cases (77%) had increased urine output after 3-5h, within 7-35h returned to normal, other 10 cases (23%) had no noticeable increase in urine and creatinine continued to increase. Therefore blood purification treatment (dialysis, filtration). Of the 10 cases, 5 cases had hemodialysis, 5 cases had filtration. The clinical situation of pre and post dialysis and filtration treatment in two groups had significiant difference. Especially in filtration groups, pre and post filtration treatment indicators (average blood pressure, urea nitrogen, creatinine, oxygen partial pressure) were significant improved. Among the patients of blood purification treatment, 5cases died the mortality 50%, 3 cases in dialysis, 2 cases in filtration. The main cause of the death was the multi organ failure. 40 cases of the discharged ARF cases underwent visit, 5 cases died, the cause of deaths is multi organ failure. Conculsion Pre-existing hypertension and post surgical hypotension is the independent risk factor of ARF after cardiac surgery. In surgical environment, correct method of disposition is most important in the preventive treatment of the ARF, and urgent diagnosis and early treatments like diuresis and active blood purification are the key factors of successive emergency treatment of post cardiac surgical ARF.
引文
1. C R Parikh, J Mishra, H Thiessen-Philbrook, B Dursun, et al. Urinary IL-18 is an early predictive biomarker of acute kidney injury after cardiac surgery. Kidney International. London, Jul 2006. Vol. 70, Iss. 1; 199
2. Yasir Abu-Omar, Chandana Ratnatunga. Cardiopulmonary bypass and renal injury, Perfusion. London, Jul 2006. Vol. 21.4; 209
3. Ilknur Bahar, Ahmet Akgul, Mehmet Ali Ozatik, Kerem M Vural, et al. Acute renal failure following open heart surgery: risk factors and prognosis .Perfusion.London, Oct 2005. Vol. 20. 6, 317
4. Obesity, Fitness & Wellness Week. Cardiopulmonary Bypass; Long-term renal replacement therapy post cardiopulmonary bypass is not likely . Atlanta: Jul 30,2005. 259.
5. Gunjan Y Gandhi, Gregory A Nuttall, Martin D Abel, Charles J Mullany, et al.Intraoperative Hyperglycemia and Perioperative Outcomes in Cardiac Surgery Patients. Mayo Clinic Proceedings. Rochester: Jul 2005. Vol. 80, 7, 862 .
6. Jos J. A. Eijkenboom, Lucas T. G. J. van Eijk, Peter Pickkers, Wilbert H. M.Peters, et al. Small increases in the urinary excretion of glutathione S-transferase Al and P1 after cardiac surgery are not associated with clinically relevant renal injury. Intensive Care Medicine. New York: May 2005. Vol. 31,5,664
7. Jaya Mishra, Catherine Dent, Ridwan Tarabishi, Mark M Mitsnefes, et al.Neutrophil gelatinase-associated lipocalin (NGAL) as a biomarker for acute renal injury after cardiac surgery. The Lancet. London, 2005. Vol. 365, 9466,1231 .
8. CHARUHASV THAKAR, SARAH WORLEY, SUSANA ARRIGAIN,JEAN-PIERRE YARED, EMIL P PAGANINI. Influence of renal dysfunction on mortality after cardiac surgery. Kidney International. Mar 2005. Vol. 67,(3) .1112.
9. Joachim Boldt, Thorsten Brenner, Andreas Lehmann, Johannes Lang, et al.Influence of two different volume replacement regimens on renal function in elderly patients undergoing cardiac surgery.Intensive Care Medicine.May 2003.Vol.29,(5);763
10.Uwe M.Fischer,Wilko K.Weissenberger,R.David Wafters,Hans J.Geissler,et al.Impact of cardiopulmonary bypass management on postcardiac surgery renal function.Perfusion.Nov 2002,Vol,17,(6),401
11.Elizabeth Bowen Fortescue,David W Bates,Glenn M Chertow.Predicting acute renal failure after coronary bypass surgery.Kidney International.Jun 2000.Vol.57,(6),2594
12.A M Zaidi,A P Fitzpatrick,D J M Keenan,N J Odom,G J Grotte.Good outcomes from cardiac surgery in the over 70s.Heart.Aug 1999.Vol.82,(2),134-138.
13.许建屏,刘楠等,心脏术后急性肾衰死亡率及其死亡相关危险因素分析,中国现代实用医学杂志,2003,2,8,1-3。
14 Llopart T,Lombardi R,Forselledo M,et al.Acute renal failure in open heart surgery.Ren Fail,1997;19(2);319-323.
15 Jachimsson PO,Stahle F,Nystrom SO,et al.Incidence of acute renal failure in open heart surgery.J Cardiothorac Anesth,1989;3(suppl 5);58.
16 赵枫,徐志云等,腹膜透析治疗体外循环心脏术后急性肾功能衰竭,第三军医大学学报,2004,25,4,454-455。
17 Lange HW,Aeppli DM,Brown DC,et al.Survival of patient with acute renal failure requiring dialysis after open heart surgery.Am Heart J.2001;113;1138-1143.
18 Kresse S,Schlee H,Deuber HJ,et al.Influence of renal replacement therapy on outcome of patient with acute renal failure;Kidney Int,1999;56(Suppl 72);s75-s78.
19 Suen WS,Mok CK,Chiu SW,et al.Risk factors for development of acute renal failure(ARF),requiring dialysis in patients undergoing cardiac surgery[J].J Vase Dis,1998,49(6);789-796.
20 Conlon PJ,Stafford-Smith M,Whit WD,et al.Acute renal failure following cardiac surgery[J].Nephrol dial Transplant,1999,14(5);1158-1162.
21 Corwin HL,Sprague SM,Delaria GA,et al.Acute renal failure associated with cardiac operation.J Thorac Cardiovasc Surg,1989,98;1107-1112.
22 Chertow GM,Levy EM,Hammermeister KE,et al.Independent association between acute renal failure and mortality following cardiac surgery[J].Am J Med,1998,104(1);343-348.
23 Mangano CM,Diamondstone LS,Ramsay JG,et al.Renal dysfunction after myocardial revascularization;risk factors,adverse outcomes,and hospital resource utilization.The Multicenter Study of Perioperative Ischemia Research Group.Ann Intern Med,1998,128(3);194-203.
24 王志农等.心脏瓣膜替换术后急性肾功能衰竭的高位因素的分析.第二军医大学学报.1995,16(2);135-137.
25 Defraigane JO,Meurisse M,Limet R,et al.Valvular and coronary surgery in renal transplant patients.J Cardio Vasc Surg {Torino},2000,31(5);1679-1683.
26 黄忠耀,陈道中,陈良万等.心脏术后急性肾功能衰竭的治疗[J].Fujian Med Univ,2004,38(1);91-92.
27 刘菁,吴若彬等.心脏术后急性肾功能衰竭的替代治疗.岭南心血管病杂志.2004,10,1,41-42.
28 Hashimoto K,Nomura K,Nakano M.Pharmacological intervention for renal protection during cardiopulmonary bypass.Heart Vessles,2003,8(4);203-210.
29 Olsen NV.Effects of dopamine on renal hemodynamic tubular function and sodium excretion in normal humans.Dan Med Bull 1998;45;282-293.
30 Ebadi M.Diuretics In:Ebadi M,eds.Pharmacology,2~(nd),Boston.Little Brown,2003:227-239.
31 Sirivella S,Gielchinsky I,Parsonnet V.Mannitol,frosemide,and dopamine infusion in postoperative renal failure complicating cardiac surgery[J].Ann Thorac Surg,2000,69(2);501-506.
32 郑知非,邱兆昆,龚宝生等。心脏手术后ARF的治疗[J].上海医学.2002,25(1):29-32.
33 Khann R,Nolph KD,Oreopoulos.The Essentials of Peritoneal Dialysis;Kluwer Academic Publishers.1993,19-33.
34 Cohen JJ,Harrington JT,Madis NE.Peritoneal dialysis.Kidney Int.2005,45;226-229.
35 何朝生等.不同血液净化方式治疗心脏手术后急性肾功能衰竭的疗效比较研究.中国血液净化.2004,vol3,No4;223-224.
36 李秀华等.10h连续性肾脏替代治疗与间歇血液透析治疗重症急性肾功能衰竭的比较.中国血液净化.2004,vol3,No3;213-215.
1. C R Parikh, J Mishra, H Thiessen-Philbrook, B Dursun, et al. Urinary IL-18 is an early predictive biomarker of acute kidney injury after cardiac surgery. Kidney International. London, Jul 2006. Vol. 70, Iss. 1; 199
2. Yasir Abu-Omar, Chandana Ratnatunga. Cardiopulmonary bypass and renal injury, Perfusion. London, Jul 2006. Vol. 21.4; 209
3. Ilknur Bahar, Ahmet Akgul, Mehmet Ali Ozatik, Kerem M Vural, et al. Acute renal failure following open heart surgery: risk factors and prognosis .Perfusion.London, Oct 2005. Vol. 20. 6, 317
4. Obesity, Fitness & Wellness Week. Cardiopulmonary Bypass; Long-term renal replacement therapy post cardiopulmonary bypass is not likely . Atlanta: Jul 30,2005. 259.
5. Gunjan Y Gandhi, Gregory A Nuttall, Martin D Abel, Charles J Mullany, et al.Intraoperative Hyperglycemia and Perioperative Outcomes in Cardiac Surgery Patients. Mayo Clinic Proceedings. Rochester: Jul 2005. Vol. 80, 7, 862 .
6. Jos J. A. Eijkenboom, Lucas T. G. J. van Eijk, Peter Pickkers, Wilbert H. M.Peters, et al. Small increases in the urinary excretion of glutathione S-transferase A1 and P1 after cardiac surgery are not associated with clinically relevant renal injury. Intensive Care Medicine. New York: May 2005. Vol. 31,5, 664
7. Jaya Mishra, Catherine Dent, Ridwan Tarabishi, Mark M Mitsnefes, et al.Neutrophil gelatinase-associated lipocalin (NGAL) as a biomarker for acute renal injury after cardiac surgery. The Lancet. London, 2005. Vol. 365, 9466,1231 .
8. CHARUHASV THAKAR, SARAH WORLEY, SUSANA ARRIGAIN,JEAN-PIERRE YARED, EMIL P PAGANINI. Influence of renal dysfunction on mortality after cardiac surgery. Kidney International. Mar 2005. Vol. 67,(3) .1112.
9. Joachim Boldt, Thorsten Brenner, Andreas Lehmann, Johannes Lang, et al.Influence of two different volume replacement regimens on renal function in elderly patients undergoing cardiac surgery.Intensive Care Medicine.May 2003.Vol.29,(5);763
10.Uwe M.Fischer,Wilko K.Weissenberger,R.David Warters,Hans J.Geissler,et al.Impact of cardiopulmonary bypass management on postcardiac surgery renal function.Perfusion.Nov 2002,Vol,17,(6),401
11.Elizabeth Bowen Fortescue,David W Bates,Glenn M Chertow.Predicting acute renal failure after coronary bypass surgery.Kidney International.Jun 2000.Vol.57,(6),2594
12.A M Zaidi,A P Fitzpatrick,D J M Keenan,N J Odom,G J Grotte.Good outcomes from cardiac surgery in the over 70s.Heart.Aug 1999.Vol.82,(2),134-138.
13.许建屏,刘楠等,心脏术后急性肾衰死亡率及其死亡相关危险因素分析,中国现代实用医学杂志,2003,2,8,1-3。
14.LIopart T,Lombardi R,Forselledo M,et al.Acute renal failure in open heart surgery.Ren Fail,1997;19(2);319-323.
15.Jachimsson PO,Stahle F,Nystrom SO,et al.Incidence of acute renal failure in open heart surgery.J Cardiothorac Anesth,1989;3(suppl 5);58.
16.赵枫,徐志云等,腹膜透析治疗体外循环心脏术后急性肾功能衰竭,第三军医大学学报,2004,25,4,454-455。
17.Lange HW,Aeppli DM,Brown DC,et al.Survival of patient with acute renal failure requiring dialysis after open heart surgery.Am Heart J.2001;113;1138-1143.
18.Kresse S,Schlee H,Deuber HJ,et al.Influence of renal replacement therapy on outcome of patient with acute renal failure;Kidney Int,1999;56(Suppl 72);s75-s78.
19.Suen WS,Mok CK,Chiu SW,et al.Risk factors for development of acute renal failure(ARF),requiring dialysis in patients undergoing cardiac surgery[J].J Vase Dis,1998,49(6);789-796.
20.Conlon PJ,Stafford-Smith M,Whit WD,et al.Acute renal failure following cardiac surgery[J].Nephrol dial Transplant,1999,14(5);1158-1162.
21.Corwin HL,Sprague SM,Delaria GA,et al.Acute renal failure associated with cardiac operation.J Thorac Cardiovasc Surg,1989,98;1107-1112.
22.Chertow GM,Levy EM,Hammermeister KE,et al.Independent association between acute renal failure and mortality following cardiac surgery[J].Am J Med,1998,104(1);343-348.
23.Mangano CM,Diamondstone LS,Ramsay JG,et al.Renal dysfunction after myocardial revascularization;risk factors,adverse outcomes,and hospital resource utilization.The Multicenter Study of Perioperative Ischemia Research Group.Ann Intern Med,1998,128(3);194-203.
24.王志农等.心脏瓣膜替换术后急性肾功能衰竭的高位因素的分析.第二军医大学学报.1995,16(2);135-137.
25.Defraigane JO,Meurisse M,Limet R,et al.Valvular and coronary surgery in renal transplant patients.J Cardio Vasc Surg {Torino},2000,31(5);1679-1683.
26.黄忠耀,陈道中,陈良万等.心脏术后急性肾功能衰竭的治疗[J].Fujian Med Univ,2004,38(1);91-92.
27.刘菁,吴若彬等.心脏术后急性肾功能衰竭的替代治疗.岭南心血管病杂志.2004,10,1,41-42.
28.Hashimoto K,Nomura K,Nakano M.Pharmacological intervention for renal protection during cardiopulmonary bypass.Heart Vessles,2003,8(4);203-210.
29.Olsen NV.Effects of dopamine on renal hemodynamic tubular function and sodium excretion in normal humans.Dan Med Bull 1998;45;282-293.
30.Ebadi M.Diuretics In:Ebadi M,eds.Pharmacology,2~(nd),Boston.Little Brown,2003:227-239.
31.Sirivella S,Gielchinsky I,Parsonnet V.Mannitol,frosemide,and dopamine infusion in postoperative renal failure complicating cardiac surgery[J].Ann Thorac Surg,2000,69(2);501-506.
32.郑知非,邱兆昆,龚宝生等。心脏手术后ARF的治疗[J].上海医学.2002,25(1):29-32.
33.Khann R,Nolph KD,Oreopoulos.The Essentials of Peritoneal Dialysis;Kluwer Academic Publishers.1993,19-33.
34.Cohen JJ,Harrington JT,Madis NE.Peritoneal dialysis.Kidney Int.2005,45;226-229.
35.何朝生等.不同血液净化方式治疗心脏手术后急性肾功能衰竭的疗效比较研究.中国血液净化.2004,vol3,No4;223-224.
36.李秀华等.10h连续性肾脏替代治疗与间歇血液透析治疗重症急性肾功能衰竭的比较.中国血液净化.2004,vol3,No3;213-215.
2. Yasir Abu-Omar, Chandana Ratnatunga. Cardiopulmonary bypass and renal injury, Perfusion. London, Jul 2006. Vol. 21.4; 209
3. Ilknur Bahar, Ahmet Akgul, Mehmet Ali Ozatik, Kerem M Vural, et al. Acute renal failure following open heart surgery: risk factors and prognosis .Perfusion.London, Oct 2005. Vol. 20. 6, 317
4. Obesity, Fitness & Wellness Week. Cardiopulmonary Bypass; Long-term renal replacement therapy post cardiopulmonary bypass is not likely . Atlanta: Jul 30,2005. 259.
5. Gunjan Y Gandhi, Gregory A Nuttall, Martin D Abel, Charles J Mullany, et al.Intraoperative Hyperglycemia and Perioperative Outcomes in Cardiac Surgery Patients. Mayo Clinic Proceedings. Rochester: Jul 2005. Vol. 80, 7, 862 .
6. Jos J. A. Eijkenboom, Lucas T. G. J. van Eijk, Peter Pickkers, Wilbert H. M.Peters, et al. Small increases in the urinary excretion of glutathione S-transferase Al and P1 after cardiac surgery are not associated with clinically relevant renal injury. Intensive Care Medicine. New York: May 2005. Vol. 31,5,664
7. Jaya Mishra, Catherine Dent, Ridwan Tarabishi, Mark M Mitsnefes, et al.Neutrophil gelatinase-associated lipocalin (NGAL) as a biomarker for acute renal injury after cardiac surgery. The Lancet. London, 2005. Vol. 365, 9466,1231 .
8. CHARUHASV THAKAR, SARAH WORLEY, SUSANA ARRIGAIN,JEAN-PIERRE YARED, EMIL P PAGANINI. Influence of renal dysfunction on mortality after cardiac surgery. Kidney International. Mar 2005. Vol. 67,(3) .1112.
9. Joachim Boldt, Thorsten Brenner, Andreas Lehmann, Johannes Lang, et al.Influence of two different volume replacement regimens on renal function in elderly patients undergoing cardiac surgery.Intensive Care Medicine.May 2003.Vol.29,(5);763
10.Uwe M.Fischer,Wilko K.Weissenberger,R.David Wafters,Hans J.Geissler,et al.Impact of cardiopulmonary bypass management on postcardiac surgery renal function.Perfusion.Nov 2002,Vol,17,(6),401
11.Elizabeth Bowen Fortescue,David W Bates,Glenn M Chertow.Predicting acute renal failure after coronary bypass surgery.Kidney International.Jun 2000.Vol.57,(6),2594
12.A M Zaidi,A P Fitzpatrick,D J M Keenan,N J Odom,G J Grotte.Good outcomes from cardiac surgery in the over 70s.Heart.Aug 1999.Vol.82,(2),134-138.
13.许建屏,刘楠等,心脏术后急性肾衰死亡率及其死亡相关危险因素分析,中国现代实用医学杂志,2003,2,8,1-3。
14 Llopart T,Lombardi R,Forselledo M,et al.Acute renal failure in open heart surgery.Ren Fail,1997;19(2);319-323.
15 Jachimsson PO,Stahle F,Nystrom SO,et al.Incidence of acute renal failure in open heart surgery.J Cardiothorac Anesth,1989;3(suppl 5);58.
16 赵枫,徐志云等,腹膜透析治疗体外循环心脏术后急性肾功能衰竭,第三军医大学学报,2004,25,4,454-455。
17 Lange HW,Aeppli DM,Brown DC,et al.Survival of patient with acute renal failure requiring dialysis after open heart surgery.Am Heart J.2001;113;1138-1143.
18 Kresse S,Schlee H,Deuber HJ,et al.Influence of renal replacement therapy on outcome of patient with acute renal failure;Kidney Int,1999;56(Suppl 72);s75-s78.
19 Suen WS,Mok CK,Chiu SW,et al.Risk factors for development of acute renal failure(ARF),requiring dialysis in patients undergoing cardiac surgery[J].J Vase Dis,1998,49(6);789-796.
20 Conlon PJ,Stafford-Smith M,Whit WD,et al.Acute renal failure following cardiac surgery[J].Nephrol dial Transplant,1999,14(5);1158-1162.
21 Corwin HL,Sprague SM,Delaria GA,et al.Acute renal failure associated with cardiac operation.J Thorac Cardiovasc Surg,1989,98;1107-1112.
22 Chertow GM,Levy EM,Hammermeister KE,et al.Independent association between acute renal failure and mortality following cardiac surgery[J].Am J Med,1998,104(1);343-348.
23 Mangano CM,Diamondstone LS,Ramsay JG,et al.Renal dysfunction after myocardial revascularization;risk factors,adverse outcomes,and hospital resource utilization.The Multicenter Study of Perioperative Ischemia Research Group.Ann Intern Med,1998,128(3);194-203.
24 王志农等.心脏瓣膜替换术后急性肾功能衰竭的高位因素的分析.第二军医大学学报.1995,16(2);135-137.
25 Defraigane JO,Meurisse M,Limet R,et al.Valvular and coronary surgery in renal transplant patients.J Cardio Vasc Surg {Torino},2000,31(5);1679-1683.
26 黄忠耀,陈道中,陈良万等.心脏术后急性肾功能衰竭的治疗[J].Fujian Med Univ,2004,38(1);91-92.
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35 何朝生等.不同血液净化方式治疗心脏手术后急性肾功能衰竭的疗效比较研究.中国血液净化.2004,vol3,No4;223-224.
36 李秀华等.10h连续性肾脏替代治疗与间歇血液透析治疗重症急性肾功能衰竭的比较.中国血液净化.2004,vol3,No3;213-215.
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27.刘菁,吴若彬等.心脏术后急性肾功能衰竭的替代治疗.岭南心血管病杂志.2004,10,1,41-42.
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29.Olsen NV.Effects of dopamine on renal hemodynamic tubular function and sodium excretion in normal humans.Dan Med Bull 1998;45;282-293.
30.Ebadi M.Diuretics In:Ebadi M,eds.Pharmacology,2~(nd),Boston.Little Brown,2003:227-239.
31.Sirivella S,Gielchinsky I,Parsonnet V.Mannitol,frosemide,and dopamine infusion in postoperative renal failure complicating cardiac surgery[J].Ann Thorac Surg,2000,69(2);501-506.
32.郑知非,邱兆昆,龚宝生等。心脏手术后ARF的治疗[J].上海医学.2002,25(1):29-32.
33.Khann R,Nolph KD,Oreopoulos.The Essentials of Peritoneal Dialysis;Kluwer Academic Publishers.1993,19-33.
34.Cohen JJ,Harrington JT,Madis NE.Peritoneal dialysis.Kidney Int.2005,45;226-229.
35.何朝生等.不同血液净化方式治疗心脏手术后急性肾功能衰竭的疗效比较研究.中国血液净化.2004,vol3,No4;223-224.
36.李秀华等.10h连续性肾脏替代治疗与间歇血液透析治疗重症急性肾功能衰竭的比较.中国血液净化.2004,vol3,No3;213-215.