先心病术后危重患儿的早期腹膜透析治疗  

Early Peritoneal dialysis after repair of congenital heart disease in children

作　　者：曾敏 李守军 王旭 闫军 李霞 

机构地区：[1]中国医学科学院协和医科大学国家心血管病中心阜外心血管病医院心血管疾病国家重点实验室,100037

出　　处：《中华胸心血管外科杂志》2013年第2期73-75,共3页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：首都医学发展科研基金（2009.1008）

摘　　要：目的探讨先天性心脏病术后早期腹膜透析（peritoneal dialysis，PD）对患儿早期预后的影响。方法回顾性分析2008年1月至2009年12月先天性心脏病手术患儿4561例中需要PD治疗患儿62例。收集PD患儿术前、术后相关变量，建立数据库。手术室或术后3h内PD治疗患儿为早期PD组，其余患儿为传统PD治疗组。结果PD治疗发生率1．36％（62／4561例）。死亡15例，早期PD组10．71％（3／28例）和传统PD组35．29％（12／34例），差异有统计学意义（P=0．036）；RIFLE标准Ⅲ期早期PD组2例（7．1％）和传统治疗组10例（29．4％），差异有统计学意义（P=0．001）。PD治疗24h后血管活性药评分和血清肌酐值早期PD组明显降低[（19．00±2．39）对（37．00±5．22），P=0．002；（50．51±21．84）μmol／L对（130．13±76．09）μmol／L，P=0．001）]。结论积极早期PD能够降低先天性心脏病术后患儿急性肾功能损伤发生率，减轻疾病严重程度，降低死亡率。Objective The mortality rate of the children after surgical repair of congenital heart disease associated with acute renal injure has been reported to be 30% - 79%. Peritoneal dialysis is the common treatment method for those patients,but the optimal time to initiate peritoneal dialysis is still controversial. The aim of this study was to investigate the clinic outcome of early peritoneal dialysis to the children following cardiac surgery. Methods We performed a retrospective chart ofchildren following cardiac surgery from January 2008 to December 2009. The total number was 4561,62 of them were performed PD treatment. Data on the PD treatment children were collected from pre-operation to hospital discharge. Early peritoneal dialysis group was defines as PD initiated at operation room or the interval between the end of operation to starting peritoneal dialysis less than 3hrs. the others were traditional PD group. Results The whole PD treatment rate was 1.36%, 15 patients died. Themortality were 10.71% （3/28） in early PD and 35.29% （12/34） in conditional PD group respectively （P = 0. 036 ）. 2 patients were met RIFLE （risk, injury, failure, loss, and end-stage renal disease, RIFLE）classification as failure grade in earlyPD group while 10 patients in traditional PD group （ P = 0. 001 ）. After PD treatment 2ghrs, the Vasoactive-Inotrope Scores and serum creatinine values were much lower in the early PD group children than those in the traditional PD group[ （19.00 ±2.39） vs（37.00±5.22）,P=0.002;（50.51 ±21.84） vs（130.13±76.09）,P=0.001）l. Conclusion This study shows that early PD can prevent the children after congenital heart surgery to develop AKI, and reduce the severity of the clinic sta-tus. Early intervention with PD is associated with low mortality.

关 键 词：先天性心脏病 腹膜透析 急性肾损伤 RIFLE诊断分级 

分 类 号：R726[医药卫生—儿科]