婴幼儿先天性心脏病术后急性肾功能不全的腹膜透析治疗  

Peritoneal dialysis treatment of young children with acute renal failure after cardiac surgery

作　　者：聂晚年[1] 陈立平[1] 

机构地区：[1]中南大学湘雅医院肾内科,湖南长沙410008

出　　处：《中国现代医学杂志》2010年第11期1726-1728,1733,共4页China Journal of Modern Medicine

摘　　要：目的总结34例低龄小儿先天性心脏病术后急性肾功能不全患者应用腹膜透析(PD)治疗的资料,评估其在小儿先天性心脏病手术后治疗急性肾功能不全的有效性。方法收集2002年6月～2008年6月间在我院行先天性心脏病手术后并发急性肾功能不全、年龄8月～6岁[平均年龄(2.6±1.8)岁]的34例患者。应用外科手术置入腹膜透析管,术后4～8h[平均(4.10±1.71)h]开始进行PD,同时予以其他综合治疗,包括强心利尿、呼吸支持等。结果 PD治疗6h后,血清K+和HCO3-得到纠正,治疗12h后基本正常,与治疗前比较差异有显著性(P<0.05,0.01);BUN、Scr在PD治疗6h后开始下降,治疗12h后两者与治疗前比较差异有显著性(P<0.01,0.05);PD治疗6h后尿量开始增多,与治疗前比较差异有显著性(P<0.01)。治愈23例(总治愈率67.65%):其中,14例PD6～102h[平均(49.05±22.67)h]后肾功能恢复正常,治愈率35.29%;9例PD10～12h[平均(8.33±3.06)h]后,因肾功能无改善或进展而改为连续性静脉-静脉血液透析滤过(CVVHDF)治疗后痊愈。死亡11例(总死亡率32.35%):其中,5例死于多器官功能衰竭,4例死于低心排血量综合征,2例死于急性肺水肿。结论低龄小儿先天性心脏病术后并发急性肾功能不全时,尽早应用PD是一种较为安全、有效的治疗方法 ,对改善患者预后有积极影响。[Objective]To collect the data from peritoneal dialysis therapy of 34 cases of young children with acute renal failure after cardiac surgery to assess the effectiveness in the treatment of acute renal insufficiency after their cardiac surgery. [Methods]34 cases of patients, aged 8 months to 6 years old [average （2.6 ±1.8）years], between June 2002 and June 2008 in hospital after cardiac surgery complicated with acute renal insufficiency, were conducted of peritoneal dialysis together with other comprehensive treatments including cardiac diuretic, respiratory support at the same time with application of surgical placement of peritoneal dialysis tubes after 4～8 h [an average of （4.10 ± 1.71）h].[Results]PD treatment results in correction of serum K＋ and HCO3-in 6 h, being back to normal in 12 h with great differences （P 0.05, 0.01） compared with pre-treatment, and decrease of BUN and Scr in 6 h,which were statistically significant （P 0.01, 0.05） in 12 h after the treatment compared with pre-treatment. Urine volume begins to increase after 6 h, compared with pretreatment with statistical significance （P 0.01）. 23 cases of the patients were cured （total cure rate is 67.65%）, 14 cases of whom returned to normal of the renal function in 6～102 h after PD [with an average of （49.05±22.67）h] with cure rate of 35.29%, 9 cases of whom recovered from change of PD to CVVHDF （ continuous veno-venous hemodiafiltration） because of no improvement or progress of the renal function in 10～12 h after PD [with an average of （8.33 ± 3.06）h]. 11 cases of the patients were dead （with a total mortality of 32.35%）： 5 cases of whom died of multiple organ failure, 4 of whom died of low cardiac output syndrome, two of whom died of acute pulmonary edema. [Conclusion]Peritoneal dialysis is required to be applied to young children complicated with acute renal failure after cardiac surgery as soon as possible, which is relatively safe, effective and has a positive impact on improving the prognos

关 键 词：先天性心脏病手术 急性肾功能不全 低龄小儿 腹膜透析 

分 类 号：R459.5[医药卫生—治疗学]