腹膜透析在急性肾损伤治疗中的应用

Application of peritoneal dialysis in the treatment of acute kidney injury

目的探讨腹膜透析对急性肾损伤的治疗效果。方法回顾42例急性肾损伤患者行腹膜透析治疗的临床资料,分析腹膜透析后血尿素氮、血清肌酐、血钾离子(K^+)、二氧化碳结合力(CO_2CP)水平的变化。结果 42例患者中治愈29例(69.05%),继续腹膜透析1例(2.38%),自动出院1例(2.38%),死亡11例(26.19%)。腹膜透析2～38 d肾功能恢复。其中血K^+1～2 d恢复正常;CO_2CP 2～4 d恢复正常;血尿素氮3～4 d内下降30.99%,5～7 d内下降53.29%;血清肌酐3～4 d内下降33.92%,5～7 d内下降57.36%。死亡患者急性肾小管坏死个体严重程度指数(acute tubular necrosis individual severity score,ATNISS)明显高于治愈患者(P<0.05)。结论腹膜透析对急性肾损伤具有较好的治疗效果,是儿童急性肾损伤治疗的最佳选择;急性肾损伤患者的预后主要取决于原发病、器官衰竭数目和ATNISS。

Objective To evaluate the therapeutic effect of peritoneal dialysis （PD） for acute kidney injury （AKI）. Methods Clinical data from 42 AKI patients undergoing PD were retrospectively analyzed. Their blood urea nitrogen （BUN）, creatinine （Cr）, potassium ion （[K^＋I） and carbon dioxide combining power （CO2CP） before and after PD were compared. Results Twenty-nine patients recovered （70.73%）, one patient remained on PD treatment （2.38%）, one patient discharged without recovery （2.38%）, and 11 patients died （26.19%）. After PD treatment renal function recovered in 2438 days, [K^＋] declined to normal level in 1 -2 days, and CO2CP returned to normal level in 2-4 days. BUN and SCr lowered by 30.99% and 53.29%, respectively, within 3 -4 days, and by 33.92% and 57.36%, respectively, within 547 days. Acute tubular necrosis individual severity score （ATNISS） was remarkably higher in died patients than in recovered patients. Conclusion PD has better therapeutic effects for AKI patients, and is the best choice for pediatric AKI. The prognosis of AKI patients mainly depends on the primary disease, the number of failed organs, and the level of ATNISS score.