连续性肾脏替代治疗救治新生儿急性肾损伤的时机选择与效果  

Timing and effectiveness of continuous renal replacement therapy for neonatal acute kidney injury

作　　者：蔡成[1] 裘刚[1] 龚小慧[1] 沈云琳[1] 颜崇兵[1] 洪文超 Cai Cheng;Qiu Gang;Gong Xiaohui;Shen Yunlin;Yan Chongbing;Hong Wenchao(Department of Neonatology,Children＇s Hospital of Shanghai,Children＇s Hospital of Shanghai Jiaotong University,Shanghai 200062,China)

机构地区：[1]上海市儿童医院、1上海交通大学附属儿童医院新生儿科,上海200062

出　　处：《中华围产医学杂志》2018年第9期592-598,共7页Chinese Journal of Perinatal Medicine

摘　　要：目的探讨连续性肾脏替代治疗（continuous renal replacement therapy，CRRT）治疗新生儿急性肾损伤（acute kidney injury，AKI）的理想时机与效果。方法回顾性分析2011年6月至2018年6月本院新生儿重症监护病房（neonatalintensivecareunit，NICU）用CRRT技术治疗的19例AKI患儿的临床资料。采用改良的RIFLE[风险（Risk）、损伤（Injury）、衰竭（Failure）、丧失（Loss）和终末期肾脏病（End-stagerenaldisease）]标准，根据CRRT开始时的肾功能水平，将患儿分为AKI1-2期组和AKI3期组。CRRT模式包括连续性静静脉血液滤过透析和血浆置换。分析19例AKI新生儿CRRT治疗前，治疗12、24和48h，及治疗结束时的血压、肾功能、电解质、酸碱平衡及血流动力学指标的变化；比较2组AKI新生儿CRRT治疗前、治疗12、24和48h及治疗结束时的肾功能指标变化，评价CRRT的效果，并观察19例新生儿的临床转归。采用Kruskal-WallisH检验或t检验对数据进行统计学分析。结果（1）19例AKI新生儿中，AKI1-2期12例，3期7例。17例选用连续性静一静脉血液滤过透析模式，2例选用血浆置换模式。CRRT治疗转流时间49-190h，平均（89．2±33．9）h。（2）19例新生儿经CRRT治疗12h后，血压即可达正常水平（40-60mmHg，lmmHg=0．133kPa），且在治疗期间可维持正常水平。CRRT治疗12h后，血pH值上升至正常范围（7.35-7．45）。CRRT治疗12h后，患儿的氧合指数可达200mmHg；治疗24h后，可升至300mmHg以上。血钾、血尿素氮和血肌酐水平在治疗12h后明显下降，治疗24h可达到正常范围。治疗24h时，患儿尿量增多。（3）AKI1-2期组新生儿CRRT治疗24h后血尿素氮和血肌酐水平明显下降。在CRRT治疗前后各时间点（治疗前、治疗24h和治疗结束），AKI3期新生儿血尿素氮和肌酐水平均高于AKI1-2期新生儿[尿素氮分别为（15．8±4．1）与（10．2±5．1）、（11．5±2．4）与（6�Objective To investigate the timing and efficacy of continuous renal replacement therapy （CRRT） in neonatal acute kidney injury （AKI）. Methods Nineteen AKI neonates treated with CRRT were enrolled during hospitalization in the Department of Neonatology of the Children＇s Hospital of Shanghai from June 2011 to June 2018. Their clinical data were retrospectively analyzed. According to their baseline renal function, these neonates were divided into two groups using an improved RIFLE （Risk, Injury, Failure, Loss and End-stage renal disease） standard： AKI stage 1-2 group and AKI stage 3 group. CRRT included continuous veno-venous hemodiafiltration （CVVHDF） and plasma exchange （PE）. Several parameters included blood pressure （BP）, renal function, electrolyte, blood gas and hemodynamic indicators were analyzed before, 12 h, 24 h, and 48 h after the initiation of CRRT and at the end of CRRT. Changes in neonatal renal function before, 24 h after the initiation of CRRT and at the end of CRRT were compared between the two groups. Efficacy of CRRT was evaluated, and clinical outcomes were analyzed. Kruskal-Wallis H-test or t-test was applied for statistic analysis. Results （1） Among the 19 neonates with AKI, there were 12 in stage 1-2 and seven in stage 3. Seventeen cases were treated with CVVHDF, and the other two underwent plasma exchange. The duration of CRRT was 49 -190 h with an average of （89.2±33.9） h. （2） After 12 h of CRRT, the blood pressure of all 19 AKI neonates returned to normal （40-60 mmHg, 1 mmHg=0.133 kPa） and was maintained at that level during the treatment. The blood pH value also increased to a normal range （7.35-7.45） at the same time. The oxygenation index reached 200 mmHg after 12 h of CRRT and rose to over 300 mmHg after 24 h. The levels of serum potassium, urea nitrogen, and creatinine decreased significantly after 12 h of CRRT and reached the normal range after 24 h of CRRT. After 24 h of CRRT, the urine volume significantly increased. （3） Serum l

关 键 词：急性肾损伤 肾替代疗法 婴儿 新生 治疗结果 

分 类 号：R722.1[医药卫生—儿科]