腹膜透析的早期干预对体外循环术后毛细血管渗漏综合症治疗作用的临床研究

The Early Intervention of Peritoneal Dialysis for Children with Capilary Leak Syndrome after Cardiopulmonary Bypass

目的探讨腹膜透析在治疗体外循环术后毛细血管渗漏综合症方面的作用.方法将2008年1月至2010年1月行全麻体循环(CPB)手术且术后发生毛细血管渗漏综合症(CLS)患儿42例,随机分为腹膜透析组(PD组)和常规治疗组(非PD组),PD组早期发现有渗漏现象即开始行腹膜透析,非PD组按照常规强心、利尿、补充胶体治疗.结果 PD组患儿的机械通气时间、ICU平均住院天数、病死率均显著低于非PD组;心功能很快恢复,渗漏现象很快改善;炎症介质IL-6、TNF-α治疗后各时段均明显低于非PD组.结论腹膜透析是治疗儿童先天性心脏病手术后毛细血管渗漏综合症的一种安全、有效的手段。

Objective To evaluate the application and principle of peritoneal dialysis（PD） treatment in capilary leak syndrome after cardiopulmonary bypass.Method Forty-two young children patients with capilary leak syndrome after cardiac surgery in our hospital from January 2008 to January 2010 were randomly divided into two groups：PD group and non-PD group.Patients in PD group received peritoneal dialysis treatment as capilary leak syndrome occured,and patients in non-PD group were given conventional therapy,including cardiotonic and diuretic treatment and colloid supplement.Results The time of mechanical ventilation and hospital day in ICU of patients were obviously shorter,and the mortality was lower in the PD group than those in the non-PD group.The heart function of patients recovered and the capilary leak syndrome disappeared faster in the PD group than those in the non-PD group.The serum levels of IL-6 and TNF-α of patients in every period of time were lower in the PD group than those in the non-PD group.Conclusion Peritoneal dialysis is a safe and effective method to cure capilary leak syndrome in children after cardiopulmonary bypass.