腹膜透析治疗重症新生儿急性肾损伤的时机和疗效  

The timing and efficacy of peritoneal dialysis in severe neonatal acute kidney injury

作　　者：廖梦 刘丹[1] 高民[1] 张晓良[1] 刘必成[1] 乔立兴[2] 王伟[2] 汤日宁[1] LIAO Meng;LIU Dan;GAO Min;ZHANG Xiaoliang;LIU Bicheng;QIAO Lixing;WANG Wei;TANG Rining(Department of Nephrology,Zhongda Hospital,Southeast University,Nanjing 210009,China;Department of Pediatrics,Zhongda Hospital,Southeast University,Nanjing 210009,China)

机构地区：[1]东南大学附属中大医院肾内科,南京210009 [2]东南大学附属中大医院儿科,南京210009

出　　处：《肾脏病与透析肾移植杂志》2023年第6期515-520,共6页Chinese Journal of Nephrology,Dialysis & Transplantation

基　　金：江苏省卫健委重点项目(ZD2022045);国家自然科学基金(82370742)。

摘　　要：目的:探讨腹膜透析(PD)治疗重症新生儿急性肾损伤(AKI)的效果与时机选择。方法:收集2014年6月至2022年12月于东南大学附属中大医院行PD治疗的AKI新生儿16例。回顾性收集患儿的基线资料、PD治疗前后尿量、肌酐及尿素氮等疗效指标,以及PD置管术后并发症情况。采用COX回归模型探究预后的影响因素,采用Wilcoxon配对法及Wilcoxon两样本比较法分析PD治疗前后的组内及组间疗效比较。结果:研究共纳入16例患儿,COX回归模型结果显示AKI 3期[HR=6.916,95%CI 1.126~42.492,P=0.037]是影响患儿预后的独立危险因素。根据PD手术方式,将患儿分成传统手术切开组(n=9)和改良经皮穿刺组(n=7),结果显示两组疗效并无明显差异。将患儿分成PD及时干预组(n=8)和延迟干预组(n=8),及时干预组患儿经过PD治疗后尿量明显增多(P=0.036);纠正代谢性酸中毒效果更明显(P=0.009)。本研究中患儿PD手术技术成功率100%,6例出现并发症(传统手术切开组4例、改良经皮穿刺组2例)。结论:PD在治疗重症新生儿AKI中是有效且安全的,早期干预有助于改善患儿预后。改良经皮穿刺法置管并发症更少、安全性更好。Objective:To analyzes the efficacy and the timing of PD in neonatal acute kidney injury(AKI).Methodology:The neonates with acute renal injury treated with PD in Zhongda Hospital,Southeast University from June 2014 to December 2022 were collected.Retrospective collection of general baseline data,efficacy indicators before and after PD treatment,as well as postoperative complications after PD catheterization.Cox regression model was used to explore the influencing factors of prognosis in pediatric patients,and Wilcoxon signed rank test and Wilcoxon two sample comparison method were used to analyze the intra group and inter group efficacy comparison before and after PD treatment.Results:A total of 16 neonates were included.The Cox regression model results showed that AKI stage 3[P=0.037,HR=6.916,95%CI(1.126,42.492)]is a risk factor affecting the prognosis of neonates.The study divided the neonates into operation incision group(OP,n=9)and improved percutaneous puncture group(Seldinger,n=7).The results showed that there was no significant difference in the efficacy between the two groups.The study divided the neonates into timely intervention with PD group(n=8)and delayed intervention with PD group(n=8),the urine volume significantly increased in the timely intervention group(P=0.036).Compared to the delayed intervention group,the timely intervention group had a more significant effect on correcting metabolic acidosis(P=0.009).All neonates were successfully implanted with PD catheters.There were 6 cases of postoperative complications,including 4 in the OP group and 2 in the Seldinger group.Conclusion:PD is effective and safe in treating severe of neonatal AKI.We suggest that timely intervention of PD,which can improve the prognosis of neonates.The improved percutaneous puncture method has has fewer complications and better safety.

关 键 词：腹膜透析 新生儿 急性肾损伤 干预时机 

分 类 号：R722.1[医药卫生—儿科]