简易腹膜透析治疗儿童重症先天性心脏病术后低心排综合征  

Simple peritoneal dialysis in the treatment of severe congenital heart disease after operation complicated with low cardiac output syndrome in children

作　　者：吴小红[1] 侯豫[1] 封志纯[1] 

机构地区：[1]北京军区总医院附属八一儿童医院儿童外科重症监护专科,北京100700

出　　处：《中华实用儿科临床杂志》2014年第23期1785-1787,共3页Chinese Journal of Applied Clinical Pediatrics

摘　　要：目的 探讨儿童重症先天性心脏病术后合并低心排综合征（LCOS）早期应用简易腹膜透析对围术期治疗的影响。方法 选择2013年1月至6月北京军区总医院附属八一儿童医院儿童外科重症监护专科（ICU）收治的53例合并LCOS的重症先天性心脏病术后应用简易腹膜透析患儿，对患儿的心、肺、肾等重要脏器功能指标进行研究。年龄2d～2岁，体质量2～8 kg。其中室间隔完整完全性大动脉转位（TGA/IVS）8例，法洛四联症（TOF）10例，肺动脉闭锁（PA）10例，主动脉弓离断（IAA）6例，完全肺静脉异位引流（TAPVC）6例，主动脉缩窄（COA）5例，右心室双出口（DORV）4例，完全心内膜垫缺损（CAVC）3例，室间隔缺损（VSD）1例。结果 治愈50例，术后简易腹膜透析治疗2～10 d，住监护室治疗时间2～15 d，尿量恢复正常1～3 d，血清肌酐、尿素氮恢复时间为术后3～10 d，乳酸降至正常时间1～3 d，其中3例因严重LCOS，复苏困难予体外膜肺氧合（ECMO）治疗，术后恢复良好；3例死亡。结论 简易腹膜透析方便、安全、创伤小、廉价、效果好，可提高患儿生存率，减少并发症，缩短呼吸机辅助呼吸时间及ICU滞留时间，节省住院时间及费用。Objective To study the effect of simple peritoneal dialysis on the treatment of severe congenital heart disease（CHD） after operation complicated with low cardiac output syndrome（LCOS） in children with perioperative therapy. Methods After operation,fifty-three cases of severe CHD complicated with LCOS and the application of easy peritoneal dialysis were collected from Jan. to Jun. 2013 in Department of Children＇s Surgical Intensive Care Specialist, Bayi Children＇s Hospital were collected. Functional parameters of vital organs, e. g. lung, kidney and heart were observed. Ages varied from 2 days to 2 years old, body weight from 2 to 8 kg. It contained 8 cases of complete transposi- tion of great arteries with intact ventricular septum（ TGA/IVS）, 10 cases of Tetralogy of Fallot（TOF）, 10 cases of pul- monary atresia （PA）, 6 cases of interruption of aortic arch （IAA）, totally anomalous pulmonary venous drainage （TAPVC） in 6 cases,5 cases of coarctation of the aorta（COA） ,4 cases with right ventricular double outlet（DORV） ,3 cases with endocardial cushion defect（CAVC） ,1 case with ventricular septal defect（VSD）. Results Fifty cases were completely cured,postoperative simple peritoneal dialysis treatment for 2 to 10 days, living ICU treatment time 2 - 15 days,urine output returns to normal 1 -3 days, serum creatinine, blood urea nitrogen recovery time after 3 - 10 .days, lactic acid to normal time 1 -3 days ,and 3 cases complicated with severe LCOS received extracorporeal membrane oxygenation therapy for difficult recovery, and postoperative recove~ was good. Three cases died. Conclusions Easy peritoneal dialysis is convenient, safe, minimally invasive, inexpensive and effective; It can improve survival rate and reduce complications, shorten the time of mechanical ventilation and ICU residence time, hospitalization time and cost savings.

关 键 词：先天性心脏病 简易腹膜透析 低心排综合征 儿童 

分 类 号：R726.5[医药卫生—儿科]