腹膜透析在小儿先天性心脏病术后低心排的应用

Application of peritoneal dialysis in the treatment of children with low cardiac output after cardiosurgery

目的观察腹膜透析对小儿先天性心脏病术后的低心排治疗效果。方法回顾性分析该院12例先天性心脏病术后低心排早期治疗使用腹膜透析效果。腹透液选择百特公司2.5%低钙腹膜透析液。单次腹膜透析量15～20 ml/kg,透析时进液时间20～30 min,保留30 min,排出20 min,视患儿血压情况而定。待出现尿液后,逐步延长腹透间隔时间。乳酸高者保留腹透时间较长(40～60 min)。根据临床表现和血清肌酐、乳酸调整透析频率。监测血糖和电解质,动静脉血气分析,及时补充胶体。记录患儿腹膜透析开始时间、持续时间和尿量恢复时间。结果尿量恢复时间为5～22 h。应用呼吸机时间为70～128 h,滞留监护室时间为5～18 d。并发症为导管堵塞3例,低血糖3例,高血糖1例,低钾血症2例。无腹膜炎及肠穿孔病例发生。2例死亡病例均为法洛四联症。死亡原因为严重低心排,多器官功能障碍。结论早期应用腹膜透析可以减轻心肺肾负担,维持内环境的稳定,降低病死率。

Objective To investigate the effect of peritoneal dialysis in the treatment of children with low cardiac output after eardiosurgery. Methods A retrospective analysis was performed on the therapeutic effect of 12 children with low cardiac output after surgery of congenital heart disease by the early peritoneal dialysis in our hospital, 2. 5% low calcium peritoneal dialysis solution was selected. The single amount of peritoneal dialysis was 15 -20 ml/kg, and dialysis fluid retention time was 20 - 30 min. After 30 min reservation, dialysis fluid was drained for about 20 rain according to tlle blood pressure. Peritoneal dialysis interval time vas extended gradually after the urine occurred. Re- tention time of peritoneal dialysis was extended if patients were suffered from hyperlactacidemia. The frequency of di- alysis was adjusted according to the the level of serum creatinine and lactate. The blood glucose, electrolytes as well as arterial and venous blood gas was monitored, and the colloid was supplied when necessary. The peritoneal dialysis start, duration and the urine recovery time was recorded. Results The urine recovery time was 5 - 22 h. The appli- cation time of ventilator was 70 - 128 h, and the time in ICU was 5 - 18 d. The complications of peritoneal dialysis included catheter blockage （ 3 cases ）, hypoglycemia （ 3 cases ）, hyperglycemia （ 1 case ） and hypokalemia （ 2 cases）. No patients suffered from peritonitis and intestinal perforation. Two cases of tetralogy of fallot were died of severe low cardiac output and multiple organ dysfunction. Conclusion Early application of peritoneal dialysis can reduce the burden of heart, lung and kidney, maintain the stability of intemal environment, and reduce mortality.