腹膜透析治疗15例新生儿的临床分析

Therapeutic analysis about the effectiveness of peritoneal dialysis in 15 neonatal babies with acute kidney injury

目的分析腹膜透析在新生儿的临床预后及合并症。方法回顾性分析新疆维吾尔自治区人民医院新生儿重症监护室接受腹膜透析治疗的15例新生儿临床基本信息,透析治疗方法,临床预后及转归。结果纳入分析的15例新生儿中男性9例,女性6例;早产儿11例;发生急性肾损伤的原发疾病:6例脓毒血症合并休克、2例重度窒息合并脓毒血症、4例脓毒血症、1例Rh溶血症合并休克、1例肾静脉血栓、1例遗传代谢病;多脏器功能衰竭46.6%(7/15),2个脏器功能衰竭26.6%(4/15),3个脏器功能衰竭20%(3/15);代谢性酸中毒66.6%(10/15),高钾血症20%(3/15),无尿46.6%(7/15),少尿13.3%(2/15),体重增加超过15%为53.3%(8/15)。开始透析的日龄(1-23)天;持续透析天数(1-25)天。4例治愈出院,死亡率73.3%(11/15):7例透析治疗中死亡,2例停止透析治疗后因家属考虑预后不良放弃治疗后死亡,1例停止透析治疗后20 d死亡,1例停止透析治疗后47 d猝死。腹膜透析治疗合并症:3例置管处渗漏、8例高血糖症、4例低钾血症、4例堵管(1例肝素钠治疗)、3例发生脱管后重新置管、1例合并腹膜炎(头孢唑林治疗)。结论腹膜透析治疗技术应用于新生儿是安全有效的。

Objective To analyze the clinical outcome and complication of peritoneal dialysis(PD)in neonatal babies.Method Neonatal babies treated with PD in the ICU of our hospital were chosen and their clinical?information,treating method of PD and outcome were retrospective analyzed.Result A total of 15 newborns were enrolled in this study including 9 males,6 females and 11 preterm infants.The primary disease for AKI included sepsis and shock in 6 cases.Severe asphyxia and shock happened in 2 cases.Sepsis was in 4 cases.Hemolytic disease of the newborn and shock happened in 1 case.Renal vein thrombosis and hereditary metabolic diseases were both1 cases.Seven of them(46.6%)had multiple organ failure,including failure of two organs in 4 cases(26.6%)and failure of 3 or more than 3 organs in 3 cases(20.0%).10 cases had(66.6%)hasmetabolic acidosis;3 cases(20%)had hyperkalemia;7 cases(46.6%)had anuria;2 cases(13.3%)had anuria oliguria;8 cases(53.5%)overweight 15%of birthweight.The date of PD was from 1 to 23 days;Continuous PD was from 1 to 25 days.Four cases were cured and discharged.mortality rate of 73.3%(11/15).7 cases died during dialysis treatment.2 cases died after giving up treatment considering poor prognosis after dialysis treatment.1 cases died 20 days after dialysis treatment,and 1 cases died suddenly after 47 days of treatment for hydrocephalus in a hospital.The PD related complications included leakage of dialysate in 3 cases,hyperglycemia in 8 cases,hypokalemia in 4 cases,obstruction of the catheters in 4 cases,drop of the catheters in 3 cases and peritonitis in 1 cases.Conclusion Emergent PD was a kind of safe and effective treatment for newborns.