改良腹膜透析在先天性心脏病术后危重患儿治疗中的应用  

The application of modified peritoneal dialysis in postoperative critically ill children with congenital heart disease treatment

作　　者：朱贵军[1] 陈兴澎[1] 蔡巍巍[1] 严哲[1] 赵勇鹏[1] 

机构地区：[1]郑州大学附属洛阳中心医院心脏外科,河南省洛阳市471009

出　　处：《中国心血管病研究》2016年第3期218-220,共3页Chinese Journal of Cardiovascular Research

摘　　要：目的探讨低龄患儿先天性心脏病术后应用改良腹膜透析（PD）的疗效及预后。方法回顾性分析郑州大学附属洛阳中心医院心脏外科2010年1月至2015年9月先天性心脏病手术患儿1200例，需要改良PD治疗21例。6例合并低心排综合征（LCOS），15例合并急性肾功能不全（ARI），年龄2d至6岁，体质量2．5-15．0kg。其中法洛四联症（TOF）4例、室间隔完整完全性大动脉转位（TGA／IVS）3例、完全心内膜垫缺损（CAVC）2例、肺动脉闭锁（PA）2例、主动脉弓离断（IAA）2例、单心室（SV）1例、完全肺静脉异位引流（TAPVC）3例、主动脉缩窄／室间隔缺损（COA／VSD）2例、右心室双出口（DORV）2例。结果应用改良PD治疗21例，治愈20例。术后改良腹膜透析治疗2-5d，住监护室治疗时间5-90d，尿量恢复正常1-3d，血清肌酐、尿素氮恢复时间为术后3-5d，乳酸降至正常时间1-2d，其中1例因严重LCOS，术后难以停机直接应用体外膜肺氧合（ECMO）治疗，死亡2例。结论改良腹膜透析在先天性心脏病术后危重患儿治疗中的应用价值是明显的，值得在基层医院推广。临床应用中的问题还有待进一步关注。Objective To discusse the curative effect and prognosis of peritoneal dialysis （PD） appliying to postoperative young children with congenital heart disease. Methods Retrospective analysis of 1200 cases of children with congenital heart disease undergoing cardiac surgery during 2010 January-2015 September, in which 21 cases need treatment of modified PD. 6 cases combined low cardiac syndrome （LCOS）, 15 cases complicating acute renal insufficiency（ARI）, age was from 2 days-6 years old, body quality was 2.5-15.0 kg. In the 21 cases, 4 cases was of tetralogy of fallot （TOF）, ventricular septal complete completeness arteries transposition（TGA/IVS） in 3, complete endocardial cushion defect （CAVC） in 2 cases, pulmonary atresia （PA） in 2 cases, aortic arch broken （IAA） was in 2 cases, single ventricle（SV） in 1 case. Completely pulmonary vein（TAPVC）, 3 cases of ectopic drainage aorta/ventrieular septal defect（COA/VSD ） in 2 cases, double outlet of right ventricle（DORV） in 2 cases. Results In the 21 cases accepted modified PD treatment, 20 cases got cure after treatment for 2-5 d, staying time in ICU was 5-90 d. The recovery time of urine was 1-3 d, of serum creatinine and urea nitrogen was 3-5 d, lactic acid drop to normal time was 1-2 d, among them 1 case direct applicated of extracorporeal membrane oxygenation（ECMO ） treatment because of serious LCOS, 2 cases died. Conclusion The curative effect of peritoneal dialysis（PD ） appliying to postoperative young children with congenital heart disease are obvious.

关 键 词：腹膜透析 改良 先天性心脏病 术后 

分 类 号：R654.2[医药卫生—外科学]