腹膜透析治疗低龄小儿心脏术后急性肾功能不全的临床观察

Peritoneal Dialysis for Acute Renal Insufficiency in Young Children after Cardiac Surgery

目的总结34例低龄小儿心脏术后急性肾功能不全患者应用腹膜透析（peritoneal dialysis，PD）治疗的临床资料，评估其在小儿心脏手术后治疗急性肾功能不全的有效性。方法收集2002年6月—2008年6月在我院行心脏手术后并发急性肾功能不全的34例患儿，应用外科手术置入腹膜透析管，术后4—8h开始进行PD治疗，同时予以其他综合治疗，包括强心利尿、呼吸支持等。结果治愈23例（67．65％）：其中14例PD治疗6～102h后肾功能恢复正常；9例PD治疗10～12h后因肾功能无改善或进展而改为连续性静脉-静脉血液透析滤过（CVVHDF）治疗后痊愈。死亡11例：其中5例死于多器官功能衰竭，4例死于低心排血量综合征，2例死于急性肺水肿。34例患儿PD治疗0—6h与6—12h K^＋、HCO^-、尿素氮、肌酐、超滤量、尿量检测结果与治疗前比较差异均有统计学意义（P〈0．05）。结论低龄小儿心脏术后并发急性肾功能不全时，尽早应用PD，是一种较为安全、有效的治疗方法，对改善患者预后有积极影响。

Objective To evaluate the effectiveness of peritoneal dialysis therapy （PD） for acute renal insufficiency in young children after they received cardiac operation through summary of data of 34 young patients with cardiac surgery complicated by acute renal insufficiency, who received PD. Methods Totally 34 young children patients with acute renal failure after cardiac surgery in our hospital from June 2002 to June 2008were enrolled. They were given PD through peritoneal dialysis tubes 4 - 8h after operation, at the same time other comprehensive therapies including cardiac, diuretic, and respiratory support. Results There 23 （67.65%） patients cured, of them 14 received 6 to 102 hours PD, and 9 received 10 to 12 hours PD followed by continuous veno - venous hemodiafiltration （CVVHDF） because their renal functions had no improvement. There were 11 patients who died, among them 5 died of multiple organ failure, 4 of low cardiac output syndrome, and 2 of acute pulmonary edema. There 34 patients whose period of PD treatment 0 -6 h and ≤6 - 12 h, and their levels of K^＋ , HCO^- , BUN and Scr, as well as ultrafiltration volume and volume of urine showed significant difference from those before treatment （ P 〈 0. 05 ）. Conclusion The peritoneal dialysis should be applied as soon as possible for young children after cardiac surgery complicated by acute renal failure. It is a safe and effective method, being of active influence to improvement of prognosis of patients.