急性间歇性腹膜透析对多器官功能障碍并急性肾损伤婴幼儿的疗效观察

Curative effect of acute intermittent peritoneal dialysis in the treatment of infants with multiple organ dysfunction syndrome and acute kidney injury

目的 探讨急性间歇性腹膜透析（AIPD）对急性肾损伤并多器官功能障碍婴幼儿的有效性及安全性.方法 选取2006年9月至2014年5月于贵州省人民医院各重症监护室住院治疗的多器官功能障碍并急性肾损伤的婴幼儿患者26例,年龄2个月至3岁.分为对照组（n=14）及AIPD组（n=12）,回顾性分析血肌酐（Scr）、尿素氮（BUN）、二氧化碳结合力（CO2CP）、血钾（K^＋）及C反应蛋白（CRP）的变化,以及患儿的肾功能恢复率与30 d病死率.结果 AIPD组Scr、BUN较治疗前显著下降（P＜0.05）,与对照组相比,亦显著降低（P＜0.05）;血K^＋较治疗前明显下降（P＜0.05）,CO2CP较治疗前明显升高（P＜0.05）;CRP较治疗前有下降趋势,但差异无统计学意义,亦低于对照组,差异亦无统计学意义.AIPD组患儿充血性心衰及肺水肿等病情改善更为明显,其肾功能恢复率达41.67％,显著高于对照组（14.29％）（P=0.003）;脱离呼吸机比率较对照组显著提高（58.33％比28.57％,P=0.086）;30 d病死率亦显著低于对照组（15.4％比36.9％,x^2=9.58,P=0.020）.结论 AIPD能有效清除MODS并急性肾损伤婴幼儿体内多余水分、毒素,纠正电解质及酸碱平衡紊乱,增加肾功能恢复率,减少病死率,是MODS并AKI低龄患儿有效的肾替代治疗方式.

Objectives To investigate the effect of acute intermittent peritoneal dialysis （AIPD） in multiple organ dysfunction syndrome （MODS） infants with acute kidney injury （AKI） and to assess the effectiveness of the treatment.Methods Twenty-six cases of MODS infants with AKI （Age for 2 months to 3 years） treated with AIPD （AIPD group,n=12） or not （Control group,n=14） in intensive care unit of People＆#39; s Hospital of Guizhou Province from September 2006 to May 2014 were retrospectively reviewed.Clinical characteristics including Scr,BUN,CO2CP,serum K^＋ and C reactive protein （CRP） before and after dialysis,mortality and renal recovery rate within 30 days were analyzed and compared between the two groups.Result After AIPD,the levels of Scr and BUN decreased significantly （P 〈 0.05）,and comparison with control group was the same; serum K^＋ declined and CO2CP increased obviously （P〈0.05）; CRP also decreased but without significant difference as well as comparison with control group.Compared with control group,these infants in AIPD group showed more significant improvement,including congestive heart failure and pneumonedema; both of renal recovery rate（41.67% vs 14.29%,P=0.003） and ventilator weaning rate （58.33% vs 28.57%,P=0.086） remarkablely raised respectively; mortality rate within 30 days significantly reduced （15.4% vs 36.9%,x^2=9.58,P=0.020）.Conclusion AIPD is a kind of effective way of renal replacement therapy,which can effectively clean out superfluous water and toxin,as well correct electrolyte imbalance,enhance renal recovery rate and reduce mortality rate,and is effective to MODS infants with AKI.