自动腹膜透析技术在慢性肾功能衰竭患儿中的应用

Application of automated peritoneal dialysis in 7 children with chronic renal failure

目的:观察自动腹膜透析(automatedperitonealdialysis,APD)对小儿慢性肾功能衰竭(CRF)的治疗效果。方法:切开植入法置入Tenckhoff透析管,选用PACxtraBaxter型自动腹膜透析机及袋装腹膜透析(PD)液,应用APD法对CRF患儿进行PD并记录相关数据。结果:7例CRF患儿男5例,女2例,开始透析时年龄中位数为12.5岁。透析时间为42天至3年。Kt/V值平均3.3±1.9,腹膜平衡试验4/5例为低平均转运,残余肾功能平均下降(0.13±0.10)ml/min月。所有患儿透析后尿毒症症状均有改善,血压下降,贫血纠正。透析前及透析后3个月身高分别为(134.1±11.8)cm和(135.8±11.4)cm,体重分别为(32.4±7.0)kg和(33.9±8.2)kg。尿素氮平均下降46%,钙磷紊乱得以改善。开始透析时营养评估白蛋白正常范围,前白蛋白和转铁蛋白下降明显,治疗3个月后改善。患儿均能耐受APD,可以正常生活及上学,生活质量得到提高。长期APD的并发症包括腹膜炎(本组发生率为每10例每月1次)、腹股沟斜疝、一过性低血钾等。结论:APD是一种有效的可长期用于CRF患儿的肾脏替代疗法,其操作简单,易于掌握,并能有效控制代谢紊乱,改善尿毒症症状,改善患儿生活质量。

Objective ：To investigate the effect of automated peritoneal dialysis （APD） on chronic renal failure in children. Methodology：Automated peritoneal dialysis was conducted by open placement of Tenckhoff dialysis catheter, application of PAC-xtra Baxter automated peritoneal dialysis machine and packed dialysate. Seven children with chronic renal failure（ CRF ） were included in this study. Results：The 7 CRF patients were 5 boys and 2 girls, with a mean age of 12.5 years at the start of APD treatment. All the patients were followed-up regularly for42 days to 3 years. The mean Kt/V was 3.3 ± 1.9. PET were studied in 5 of the patients with 4 classified as low-average transport. The declinement of serum creatinine clearence rate was （0. 13 ±0. 10 ）ml/min every month. High blood pressure was controlled and anemia approve- ment observed in all the patients. The means of body hight was （ 134. 1 ± 11.8） cm before dialysis and （ 135.8 ± 11.4 ） cm after three months while the mean body weight was respectively （32.4 ± 7.0） kg and （33.9 ± 8. 2） kg. BUN decreased by 46%. And serum calcium and phosphorus disorders were corrected. At the start of APD, serum albumin was normal but prealbumin and transferrin decreased significantly. After three months＇ treatment, serum prealbumin and transferrin improved after. All the children returned to school with the catheter and their life quantity was improved. Complications included peritonitis （ the incidence in our study is once every 10 patients, month）, indirect hernia and low potassium. Conclusion ： APD is an easy and effective renal replacement chose for school children with chronic renal failure. Advantages included higher life quantity and better return to school and improvement in nutrition and physical development.