心脏术后急性肾损伤的临床诊疗探讨

摘要

心脏术后发生急性肾损伤( AKI)是心脏术后常见且危重的并发症之一。体外循环期间往往会发生血流动力学紊乱、低流量、灌注不足等因素使得肾血管收缩、血流量减少，导致机体内环境发生一系列的病理生理变化而发生AKI。随着体外循环设备日趋完善以及手术质量的提高，因体外循环灌注引起肾功能不全的发病率已趋于下降，但危重患者和重大手术，如大血管手术、复杂先天性心脏病的矫治以及多瓣膜置换等手术，因长时间体外转流和主动脉血流阻断后发生肾功能损害的概率仍然较高。尽早采取预防性保护治疗措施可明显提高心脏术后AKI的生存率和生存质量。%Acute kidney injury( AKI) is one of common and serious complications associated with heart surgery. Postoperative AKI after cardiopulmonary bypass( CPB) is caused by many factors,such as renal vas-cular contraction and blood fiow diminish induced by hemodynamics disorder,low flow,low perfusion pres-sion. Along with the development of CPB equipment and the improvement of operation quality,the morbidity of AKI during CPB is in a down trend. But some operations like critically ill patients with large vascular sur-gery,complex congenital heart disease operation and multiple valve replacement still have high renal damage incidence due to the long time CPB and aortic blood flow block. Early preventive protective therapies for AKI may improve survival rate and quality of life.