Korean Journal of Nephrology 1995;14(2):182-190.

개심술에 따른 급성 신부전의 발생 위험 인자 및 임상 경과에 대한 연구

김문재 , 송준호

Abstract

Acute renal failure (ARF) after open heart surgery (OHS) is a serious complication with high mortality. Previously reported incidence of severe ARF was from 0.8% to 5.6% with average of 2.7%, and mortality has been reported to be more than 60%. In Korea, the number of valvular heart and congential operation is greater than that of coronary artery surgery. To evaluate perioperative features and courses of ARF, we have analyzed 532 patients performed OHS in Inha University Hospital for eight years. 1) Overall incidence of ARF was 7.4% and that of severe, dialysis-requiring ARF was 2.3%. Inci- dence of ARF was higher in valvular heart disease (13.6%) than in congenital heart disease (3.4%). Incidence of ARF increased with advanced age and was 40% in seventh and 100% in eighth decades. 2) There was more frequent history of previous myocardial ischemia and use of diuretics in ARF group in compariosn to control group (15.4% vs 2.6%, 5.1% vs 0%, retrospectively). ARF group sho- wed more decreased cardiac function and more increased left ventricular end-diastolic dimension in echocardiogram in comparison to control group (61.6±16 mrn vs 53± 13 mm)(p<0.05). 3) The most significantly different features during operation was total cardiopulmonary bypass time, proven to be 13461 minutes in ARF group and 106±42 minutes in control group(p<0.05). Especially total cardiopulmonary bypass time of severe, dia- lysis-requiring ARF was 165±76 minutes, which is significantly longer than that of nonsevere ARF. 4) The renal replacement therapy was done in 30.8% of ARF patients. Most common indication was volume overload (83.3%), and acute peritoneal dialysis was more frequently applied than hemo- dialysis because most patients were hemodynami- cally unstable(91.9%). 5) Overall mortality of total ARF was 46.2%. The mortality of severe, dialysis-requiring ARF group was 83.3%, while non dialysis-requiring ARF was 29.6% (p<0.05%). Oliguric type renal failure occupied 38.5% among ARF and showed higher mortality (92.9%) compared to non-oliguric type (20%) (p<0.05). 6) The features of oliguria, long use of vaso- pressor and low cardiac output state were more prominent in deaths than survivors of ARF (72.2% vs 9.5%, 72.2% vs 19.0%, retrospectively) (p<0.05). So, we concluded that age, preoperative cardiac dysfunction, type and number of cardiac lesion and prolongation of total cardiopulmonary bypass time are main factors predicting development of ARF in postoperative period, and that postoperative cardiac dysfunction, pattern of ARF (oliguric or not) is another important factors predicting mortality.