阶梯序贯疗法治疗头孢曲松致儿童肾后性急性肾衰竭  

Step sequential therapy for treating children with post - renal acute renal failure induced by Ceftriaxone

作　　者：邓永继[1] 马耿[1] 朱小江[1] 

机构地区：[1]南京医科大学附属南京儿童医院泌尿外科,210008

出　　处：《中华实用儿科临床杂志》2016年第5期359-362,共4页Chinese Journal of Applied Clinical Pediatrics

摘　　要：目的探讨头孢曲松致儿童肾后性急性肾衰竭（ARF）的治疗措施。方法收集分析2012年6月至2014年6月收治的7例头孢曲松相关性肾后性ARF患儿的临床资料。根据患儿尿量、血肌酐（Cr）／尿素氮及血钾水平变化，采用碱化尿液、山莨菪碱解痉的液体疗法、逆行输尿管插管（RUC）引流术和腹膜透析以阶梯序贯的方式进行治疗。结果7例患儿均在体液丢失状态下静脉注射头孢曲松，使用头孢曲松后到出现腹痛、突然无尿／少尿时间为2．6d，B超和CT显示双侧肾盂、输尿管多发结石。人院时血BUN15．2～37．9mmol／L[（23．3±8．6）mmol／L]；血Cr为180～636μmol／L[（378．9±148．4）μmol／L]均符合ARF诊断标准。7例患儿中采用单纯液体疗法2例（28．6％），在液体疗法的基础上实施RUC引流术4例（57．1％），在液体疗法基础上实施RUC引流效果不佳者，行腹膜透析1例（14．3％）。7例（100％）均获存活，肾功能恢复正常平均时间4．4d，尿量、电解质均恢复正常。1例患儿出院后1个月随访有结石残留。1例患儿获得结石标本，并行结石成分分析为头孢曲松钙。结论采取以液体疗法、RUC引流、腹膜透析等方法，以阶梯序贯疗法的方式递进治疗是治疗儿童头孢曲松相关性肾后性ARF的有效手段。Objective To analyze the clinical characteristics and treatment of post - renal acute renal failure （ARF） induced by Ceftriaxone in children. Methods The clinical data of 7 cases of post - renal acute renal failure in children from June 2012 to June 2014 induced by Ceftriaxone were analyzed. According to the changes in urine volume, serum creatinine, blood urea nitrogen and serum potassium level, liquid therapy, retrograde ureteral catheterization （RUC） and peritoneal dialysis was performed by step sequential therapy respectively. Results Seven cases were given intravenous Ceftriaxone under the fluid loss state. Abdominal pain, sudden anuria or oliguria appeared in the children af- ter 2.6 d on the average, B ultrasonography and CT scanning showed multiple calculus in the bilateral renal pelvis and ureteral calculi. Blood BUN was 15.2 -37.9 mmol/L[ （23.3 ± 8.6） mmol/L], and blood Cr was 180 -636 μmol/L [ （378.9 ± 148.4） μmol/L]. These indicators met the diagnostic criteria for acute renal failure. In 7 cases,2 cases （28.6%） received fluid therapy of sodium bicarbonate alkalization and anisodamine spasmolytic ,4 cases （57.1% ） re- ceived fluid therapy and RUC,and 1 case （ 14.3% ） underwent fluid therapy and RUC and peritoneal dialysis. All of 7 cases （ 100% ） were alive. In the average 4.4 days renal function of 7 cases was returned to normal, and urine volume and electrolyte were also restored. Conclusions Step sequential therapy including fluid therapy, RUC and peritoneal dialysis is effective with post - renal ARF in children induced by Ceftriaxone.

关 键 词：头孢曲松 急性肾衰竭 肾后性 儿童 

分 类 号：R726.9[医药卫生—儿科]