腹膜透析治疗婴幼儿先天性心脏病术后急性肾功能不全临床研究  

Clinical application of peritoneal dialysis after surgery for congenital heart disease in infants

作　　者：朱耀斌[1] 李晓锋[1] 范祥明[1] 李志强[1] 刘爱军[1] 李刚[1] 张晶[1] 刘迎龙[1] 

机构地区：[1]首都医科大学附属北京安贞医院小儿心脏中心,北京100029

出　　处：《中华实用诊断与治疗杂志》2013年第7期636-638,共3页Journal of Chinese Practical Diagnosis and Therapy

基　　金：首都医科大学基础-临床科研合作基金项目(13JL26;11JL50);国家自然科学基金(30471721);国家自然科学基金(30670928);国家自然科学基金(81070055);科研基地-科技创新平台项目(PXM2011_014226_07_000060);北京市自然科学基金资助项目(7112046;7122056);北京市医药产品和技术重大项目培育研究项目(Z101107050210020);北京市科委首都市民健康项目(Z111100074911001);北京市卫生系统高层次卫生技术人才培养项目资助(领军人才2011-1-4)

摘　　要：目的评估腹膜透析术在婴幼儿先天性心脏病(先心病)术后急性肾功能不全的治疗效果。方法先心病术后出现急性肾功能不全患儿57例采用腹膜透析术进行治疗,观察腹膜透析治疗效果及并发症,比较腹膜透析前、后血清肌酐、尿素氮、乳酸水平及pa(O2)。结果存活43例,死亡14例,病死率24.6%,其中死于循环功能衰竭8例,多器官功能衰竭3例,急性呼吸窘迫综合征3例;19例(33.3%)出现腹膜透析管道引流堵塞,其中15例加用肝素生理盐水冲洗后管道引流通畅,4例重新放置腹膜透析管道;2例出现切口感染,加强切口换药后痊愈;1例腹膜透析呈血性,重新缝合固定后腹膜透析液颜色正常;2例释放透析液血压骤降,调整腹膜透析液体量,血流动力学平稳;患儿腹膜透析前、后血清肌酐、尿素氮、乳酸水平及pa(O2)比较差异有统计学意义(P<0.05)。结论腹膜透析术治疗婴幼儿先心病术后急性肾功能不全安全有效、操作简单、并发症低。Objective To evaluate the therapeutic effect of peritoneal dialysis on acute renal insufficiency after surgery for congenital heart disease in infants.Methods Fifty-seven infants with congenital heart disease received peritoneal dialysis for acute renal failure following cardiac surgery.The effect of peritoneal dialysis was observed,the peritoneal dialysis complications were recorded,and the peritoneal dialysis serum creatinine,blood urea nitrogen,lactic acid and arterial oxygen pressure were compared before and after dialysis.Results In these 57 cases,43 cases survived and 14 died,with the fatality rate of 24.6%,in which 8 cases died of circulatory failure,3 died of multiple organ failure and 3 died of acute respiratory distress syndrome.In 19 patients（33.3%） of peritoneal dialysis catheter drainage blockage,the catheter was unobstructed in 15 cases after heparin saline flush,and peritoneal dialysis catheter was replaced in 4 cases.Incision infection occurred in 2 cases,and was cured after the incision dressing.Peritoneal dialysis fluid was bloody,and became normal after adjusting in one case.Blood pressure dropped suddenly after the release of dialysis fluid and fluctuated greatly in 2 cases.and the hemodynamic changes got steady after adjusting the volume of peritoneal dialysis liquid.There were no significant differences in serum creatinine,blood urea nitrogen,serum lactate and arterial partial pressure of oxygen after peritoneal dialysis（P0.05）.Conclusion Peritoneal dialysis technology is an effective method to treat acute renal insufficiency after surgery for congenital heart disease in infants,with simple procedures and low complications.

关 键 词：先天性心脏病 急性肾功能不全 腹膜透析 

分 类 号：R726.5[医药卫生—儿科]