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进行手术的透析患者的内科处理

Authors
Neil S Sanghani, MD
Ramesh Soundararajan, MD, FACP
Liza M Weavind, MBBCh, FCCM, MMHC
Thomas A Golper, MD
Section Editor
Jeffrey S Berns, MD
Deputy Editor
Alice M Sheridan, MD
Translators
孙晶娣, 副主任医师，副教授

引言

关于要接受手术的透析患者最佳内科处理方面，目前已发表的数据有限。本专题将总结术前评估和术后治疗(包括疼痛控制)。

包括肾脏替代治疗在内的术后急性肾损伤相关问题将在别处讨论。 (参见“成人急性肾损伤的肾脏替代疗法(透析)：适应证、时机及透析剂量”和“急性肾损伤(急性肾衰竭)的治疗概述”和“紧急血液透析处方”)

手术并发症发病率和死亡率

与非终末期肾病(end-stage renal disease, ESRD)人群相比，透析患者的围手术期死亡率更高[1-3]。例如，一项研究纳入1157例接受腹主动脉瘤修复术的ESRD患者，接受开放性修复术患者的围手术期死亡率为16%，而接受内镜修复术患者的围手术期死亡率为10%[3]。与之相比，报道的一般人群接受开放性修复术和内镜修复术的围手术期死亡率分别为1%-5%和约1%[4-6]。

透析相关的手术并发症发病率和死亡率增加的原因，可归因于许多因素：

●冠状动脉疾病和心肌功能障碍的发生率较高

                             

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Literature review current through: 2017-06 . | This topic last updated: 2016-11-16.
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