腹膜透析治疗22例新生儿急性肾损伤的疗效分析  

A therapeutic analysis of the effectiveness of peritoneal dialysis in 22 neonatal babies with acute kidney injury

作　　者：杨杰[1] 肖菲[1] 陈佳[1] 万静芳[1] 蔡明玉[1] 龚文姜[1] 余艳 何娅妮[1] YANG Jie;XTAO Fei;CHEN Jia;WAN Jing-fang;CAI Ming-yu;GONG Wen-jiang;YU Yan;HE Ya-ni(Department of Nephrology,Daping Hospital &Surgery Institute,Army Medical University,Chongqing 400042,China)

机构地区：[1]陆军军医大学大坪医院野战外科研究所肾内科,重庆400016

出　　处：《中国血液净化》2018年第12期806-809,共4页Chinese Journal of Blood Purification

摘　　要：目的分析急诊腹膜透析治疗急性肾损伤(acute kidney injury,AKI)新生儿的临床预后及并发症。方法回顾性分析陆军军医大学大坪医院新生儿重症监护室(intensive care unit,ICU)接受急诊腹膜透析治疗的22例AKI患儿的Apgar评分,AKI分期、合并多器官功能衰竭数目、是否使用血管活性药物及机械通气、腹膜透析治疗的剂量及时间、并发症、30天存活率等。疗效指标包括:肾功能、电解质、乳酸水平等,并使用Cox回归模型分析影响存活率的因素。结果纳入分析的22例患儿中男性12例,女性10例,平均胎龄(34.95±4.34)周,体质量为(2.44±0.92)kg,出生Apgar评分为(7.32±3.05)分,AKI1期患儿占13.64%(3/22),AKI2期患儿占22.73%(5/22),AKI3期患儿占63.64%(14/22)。导致AKI的原发疾病为新生儿肺炎9例,脓毒血症6例,宫内窒息4例,其他3例。合并多器官功能衰竭的占77.27%(17/22),其中2个器官衰竭占27.27%(6/22),3个及以上器官衰竭占50.0%(11/22),需机械通气占72.73%(16/22),使用血管活性药物比例为68.18%(15/22)。腹膜透析治疗时间平均为(154.00±103.76)h,治疗剂量为(388.71±28.48)ml/(kg·d)。22例患儿中存活9例,死亡13例,30天存活率为40.9%(9/22)。Cox回归模型分析显示:AKI3期、使用血管活性药物、机械通气及3个以上器官衰竭是患儿存活的影响因素。多因素回归分析显示:使用血管活性药物是显著影响患儿预后的独立危险因素。腹膜透析相关并发症的发生包括:透析液泄漏2例,出口部位出血2例,网膜阻塞导管3例,无腹膜透析相关性腹膜炎发生。结论急诊腹膜透析治疗新生儿急性肾损伤是安全有效的,预后主要与患儿的全身基础情况相关。Aim To analyze the clinical outcome and complication of emergent peritoneal dialysis(PD)in neonatal babies with acute kidney injury(AKI). Method This was a retrospective and cohort study. AKI neonatal babies treated with PD in the ICU, Department of Daping Hospital, Amy Medical University were analyzed. Apgar score, clinical stage of AKI, organs involved in multiple organ failure, vasoactive drugs, mechanical ventilation, dose, frequency and complications of PD, and 30~day survival rate in these babies were recruited. The indices of therapeutic effectiveness included renal function, electrolyte levels and lactate levels.Cox regression model was used to analyze the factors affecting survival rate. Results A total of 22 AKI newborns(12 males and 10 females) were enrolled in this study. Their average gestational age was(34.95±4.34)weeks, average weight was(2.44±0.92) kg, and Apgar score at birth was(7.32±3.05). Three neonatal babies(13.64%) had AKI at stage Ⅰ, 5 babies(22.73%) at stage Ⅱ, and 14 babies(63.64%) at stage Ⅲ. The primary disease for AKI included neonatal pneumonia(9 cases), sepsis(6 cases), intrauterine asphyxia(4 cases) and other diseases(3 cases). Seventeen of them(77.27%) had multiple organ failure, including failure of two organs in 6 cases(27.27%) and failure of 3 or more than 3 organs in 11 cases(50.0%). Mechanical ventilation was conducted in 16 cases(72.73%) and vasoactive agents were used in 15 cases(68.18%). The average duration of PD was(154±103.76)h and the average dose was(388.71±28.48)ml/(kg· d). Nine cases survived and13 cases died with the 30-day survival rate of 40.9%. Cox regression model analyses revealed that the key factors affecting the survival rate were AKI stage III, use of vasoactive drugs, mechanical ventilation and failureof more than 3 organs. Multivariate regression analyses showed that the use of vasoactive agents was an independent risk factor for prognosis. The PD related complications included leakage of dialysate(2 cases), exitsite bleeding(2 cases) and obs

关 键 词：腹膜透析 急性肾损伤 新生儿 疗效 

分 类 号：R459.5[医药卫生—治疗学]