床旁连续性静-静脉血液透析滤过治疗儿童急性肾损伤

Continuous veno-venous hemodiafiltration on acute kidney injury in children

目的探讨连续性静-静脉血液透析滤过（continuous veno—venous hemodiafiltration，CVVHDF）治疗危重病儿童合并急性肾损伤（acute kidney injury，AKI）的作用并评估其疗效。方法2008年1月至2010年12月，对收入我院重症监护室的24例合并AK／的患儿进行CVVHDF治疗，观察治疗前及治疗后6、12、24、48、72h血肌酐（creatinine，Cr）、尿素氮（blood ure anitrogen，BUN）、K＋、Na＋、HC03-水平的变化，统计住院后28d病死率。结果24例患儿均顺利置管并完成CVVHDF治疗，平均持续时间为46h（16～142h）。CVVHDF治疗前血Cr、BUN水平分别为（340．6±298．2）ixmol／L、（31．6±11．3）mmol／L，治疗6h后Cr、BUN明显下降[（196．3±112．4）μmoL／L、（13．3±8．5）mmol／L]（P〈0．05，P〈0．01）；12h后下降更明显[（106．1±84．2）μmol／L、（10．2±9．7）mmol／L]（P〈0．01）；48h后恢复正常水平。CVVHDF治疗6h后血K＋、Na＋、HC03-紊乱状态好转，至24h时恢复至该年龄正常水平。28d病死率为29．2％（7／24），死亡者均为合并多器官功能障碍综合征的患儿。结论CVVHDF治疗儿童AKI可以迅速清除Cr、BUN及多余水分，改善。肾功能，纠正体液电解质紊乱。

Objective To investigate the effect and outcome of critically illness with acute kidney injury （AKI） treated with continuous veno-venous hemodiafiltration （CVVHDF） in children. Methods Twenty-four cases of critically illness with AKI were treated with CVVHDF in our pediatric intensive care unit from Jan 2008 to Dec 2010. The levels of creatinine （Cr）, blood urea nitrogen （BUN） , K＋ , Na ＋ and HCO3 were observed before CVVHDF and 6,12,24,48,72 h after CVVHDF. Results Catheter was successfully established for CVVHDF in 24 cases of AKI. The average duration of CVVHDF was 46 h （ 16 - 142 h）. The blood levels of Cr and BUN were significantly decreased at 6 h after CVVHDF E （ 196. 3 ± 112.4 ） μmol/L, （ 13.3 ± 8.5 ） mmol/L] and 12 h after CVVHDF E （ 106. 1 ± 84. 2 ） μmol/L, （ 10. 2 ±9.7 ） mmol/L] as compared to those before treatment E （340. 6 ±298.2） μmol/L, （31.6 ± 11. 3） mmol/L] （P 〈 0. 05 ,P 〈 0. 01 ）. After 48 h of CVVHDF, the Cr, BUN returned to normal range. The imbalance of blood K＋ , Na＋ , and HCO3- improved at 6 h after CVVHDF and returned to nomal levels at 24 h. Total 28 d fatality rate was 29. 2% （7/24）, and all death cases were complicated with multiple organ dysfunction syndrome. Conclusion CVVHDF therapy for AKI can quickly clear Cr, BUN and excess water, correct electrolyte disorders, improve kidney function in children.