婴幼儿复杂先心病术后急性肾衰竭的腹膜透析治疗及与C-反应蛋白的关系研究  

Peritoneal Dialysis for Acute Renal Failure Following Cardiac Surgery of Infants with Complicated Congenital Heart Disease and Its Relationship with C-reactive Protein

作　　者：敖翔[1] 周巧玲[1] 李强翔[2] 张卫茹[1] 聂晚年[1] 

机构地区：[1]中南大学湘雅医院肾内科,湖南省长沙市410008 [2]中南大学行政管理学院博士后流动站

出　　处：《中国全科医学》2010年第10期1073-1075,共3页Chinese General Practice

基　　金：湖南省科技厅(2007FJ4135)

摘　　要：目的探讨腹膜透析(PD)对婴幼儿复杂先心病术后急性肾衰竭的疗效及与C-反应蛋白(CRP)的关系。方法2007年1月—2009年1月在我院因复杂先心病术后急性肾功能衰竭接受了PD治疗的患儿18例,观察PD前及PD终止后1d血尿素、血肌酐、K+、Na+、Ca2+、二氧化碳结合率、平均动脉压、CRP及尿量的变化。结果2例因多器官功能衰竭死亡,余16例存活,死亡率11.1%,所有病例均未出现腹膜炎、腹透管堵塞、出血等PD的常见并发症。存活病例平均PD天数为(3.6±1.4)d。存活病例PD前后CRP均高于正常值(8mg/L)。PD终止后1d的血尿素、血肌酐、K+、CRP均较PD前明显降低(P<0.01),而二氧化碳结合率、平均动脉压、尿量均较PD前明显升高(P<0.01),Na+、Ca2+在PD前后无明显变化(P>0.05),CRP下降幅度与血尿素、血肌酐下降幅度呈正相关(r1=0.747,P<0.01;r2=0.515,P<0.05),而与尿量变化、超滤量、血K+下降幅度、平均动脉压上升幅度无明显相关(r值分别为-0.062、0.377、0.443、0.198,P>0.05)。结论PD对婴幼儿复杂先心病术后急性肾衰竭的治疗安全有效。婴幼儿复杂先心病术后急性肾衰竭中CRP升高,腹膜透析对CRP的改善可能与对血尿素、血肌酐的清除有关,而与水的超滤、电解质、平均动脉压和尿量变化无关。Objective To investigate the therapeutic effects of peritoneal dialysis （PD） on acute renal failure following cardiac surgery of infants with complicated congenital heart disease and its relationship with C - reactive protein （CRP）. Methods From January 2007 to January 2009, 18 infants who underwent peritoneal dialysis because of acute renal failure following cardiac surgery of infants with complicated congenital heart disease were analyzed. Before PD and the 1 st day after the end of PD, the changes of blood urea, serum creatinine, potassium, sodium, calcium, carbon dioxide combining power （CO2CP） , mean arterial pressure, CPR and urine volume were detected. Results There were 2 patients who died of multiple organ failure, mortality was l 1.1%. There was no common complication of peritoneal dialysis such as peritonitis, blockage of peritoneal dialysis tube, bleeding. The levels of CRP of the survival patients per -PD and post -PD were higher than normal （8 mg/L）. Compared with pre - PD, blood urea, serum creatinine, potassium and CRP of post - PD decreased remarkably （ P 〈 0. 01 ） , CO2 CP, mean arterial pressure and urinary volume of post - PD increased evidently （ P 〈 0. 01 ） , no obvious change was found in levels of serum sodium and calcium （ P 〉 0.05 ）. The range of decreased CRP was positively correlated with the ranges of decreased blood urea and serum creatinine （ r1 = 0. 747, P 〈0. 01 ; r2 = 0. 515, P 〈0. 05 ） , and not correlated with changes of urinary volume and uhrafiltration volume, range of decreased potassium, range of increased mean arterial pressure （ r = - 0. 062, 0. 377, 0. 443, 0. 198, P 〉 0. 05 ）. Conclusion Peritoneal dialysis is an effective and safe method for treating acute renal failure after cardiac operation in infants with complicated congenital heart disease. C - reactive protein increases in acute renal failure after cardiac operation in infants. Amelioration of CRP by peritoneal dialysis maybe relates with clearance of blood urea an

关 键 词：先天性心脏病 腹膜透析 急性肾衰竭 C-反应蛋白 

分 类 号：R725.41[医药卫生—儿科]