阶梯序贯疗法救治三聚氰胺致婴幼儿肾后性急性肾功能衰竭

Step sequential therapy in rescuing infantile postrenal acute renal failure induced by melamine

目的探讨三聚氰胺致婴幼儿肾后性急性肾功能衰竭（ARF）的救治方法。方法依据有特定奶粉喂养史及中华儿科学会肾脏组1994年小儿ARF诊断标准纳入病例。依据患儿病情，阶梯序贯应用液体疗法碱化尿液，膀胱镜逆行输尿管引流、腹膜透析救治患儿，对出现排尿者测定首次尿pH。结果南京医科大学附属南京儿童医院纳入符合标准的病例34例，均有无尿症状。应用液体疗法17例（50％），液体疗法＋膀胱镜逆行输尿管引流9例（26．5％），液体疗法＋膀胱镜逆行输尿管引流＋腹膜透析4例（11．8％），紧急腹膜透析4例（11．8％）。34例（100％）均获存活。第1天、第2天、第3天以后出现排尿者其首次尿pH分别为6．1±1．0、6．5±0．7，5．3±0．4，其差异具有统计学意义（F=4．563，P=0．026）。结论液体水化碱化尿液和阶梯序贯疗法是三聚氰胺致婴幼儿肾后性ARF衰竭的重要有效救治手段。

Objective To investigate clinical characteristics and emergency managements of postrenal acute renal failure （ARF） induced by melamine in infant. Method Fluid therapy for urine alkalization and hydration, cistoscope drainage and peritoneal dialysis step by step were exerted in those who had both a history of certain milk intake and ARF according to the definition of pediatric ARF which developed by Pediatric Nephrology Assembly of Chinese Pediatric Association in 1994. Results Thirty-four postrenal ARF cases with anuria due to melamine in Nanjing Children＇s Hospital of Nanjing Medical University were involved in the study. Seventy cases （50%） received fluid therapy only. Nine cases （26.5%） received fluid therapy and cistoscope drainage, and 4 cases （ 11.8 % ） received fluid therapy and cistoscope drainage and peritoneal dialysis. Four cases （ 11.8 % ） received urgent peritoneal dialysis due to severe hyperkalemia. All cases （100%） survived. The urine pH at the first day, the second day, and after the second day in those who just pass away urine were 6.1± 1.0,6.5± 0.7,5.3 ±0.4, respectively （ F = 4. 563, P = 0.026）. Conclusions Fluid therapy for urine alkalization and hydration and step sequential therapy are effective in infant with pestrenal ARF induced by melamine.