摘要
目的为了解尿毒症透析患者接受手术治疗是否有更高的危险性,与非尿毒症患者有何不同,该如何对这些患者进行围手术期处理,我们进行了回顾性研究。方法对我院25例尿毒症透析患者(透析组)以及同期进行类似手术的34例非尿毒症患者(对照组)检测术前的实验室指标,评估患者的心功能,进行麻醉分级并观察患者的术中输血及补液量,制订手术后尿毒症透析患者的透析方案。结果尿毒症透析患者术前血红蛋白和白蛋白分别为78 g/L和34.9 g/L,均低于非尿毒症对照组。术前行心功能和麻醉ASA分级,尿毒症透析患者更差。术中尿毒症透析患者接受输液总量明显少于对照组。术后透析患者能继续规律透析治疗。结论尿毒症透析患者能进行各种手术,但接受手术的风险大,做好围手术期处理有利于患者更好地耐受手术。
Objective To investigate if the dialysis patients would be more dangerous than control when they receive operation, and the management for these patients. Methods Twenty-five patients underwent the operations except those for internal arteriovenous fistula, fistulation for grafts and renal transplantation in our hospital were included. Thirty-four patients of normal renal function receiving similar operations at the same time were the controls. The blood pressure, hemoglobin, Hct, albumin, renal function and blood gas analysis, electrolyte were detected and the cardiac function was estimated by NYHA standard and anesthesia ASA physical status classification level. The changes of dialytic scheme after operation were recorded. Results Hemodialysis patients ready for selective operation received a hemodialysis during 24 to 48 h before operation. The patients receiving the emergency operation had the normal hemodialysis prior to operation. The peritoneal dialysis （PD） patients received normal PD till operation. Before operation, all dialysis patients had obvious anemia with the average hemoglobin of 78 g/L compared to 131.3 g/L in the control, more malnutrition with the albumin of 34.9 g/L to 39.8 g/L in the control. No difference in blood gas analysis and electrolyte was found between two groups. Control patients （14.7% grade 2） had better cardiac function than dialysis patients （55.1% grade 2）. The anesthesia ASA class was grade 3 or 4 in about 40% dialysis patients, and grade 3 or lower in control. During operation, blood transfusion were done in 8 dialysis patients and 5 controls （P 〉 0.05 ）, but the transfusion volume was less in dialysis patients than controls, 986 ml vs 1 547 ml. 22 patients, who receive hemodialysis after operation, would receive normal HD treatment on 2.4 d after operation. Dialysis patients had more postoperative hospitalization days than the control, 17.3 vs 10.4 d. There were 3 perioperative deaths in dialysis patients and only 1 in control （ P 〉 0.05 ）. All survival dialysis patients returned their dialysis therapy. Conclusion Dialysis patients could receive all kinds of operation, although there are more danger. Meticulous perioperative management may be the key factor in the improvement of early results.
出处
《第三军医大学学报》
CAS
CSCD
北大核心
2006年第11期1257-1259,共3页
Journal of Third Military Medical University
关键词
透析
手术
围手术期处理
dialysis
operation
perioperative management
