腹膜透析和血液滤过治疗婴幼儿先天性心脏病术后并发急性肾功能损害疗效比较

Comparison of peritoneal dialysis versus continuous renal replacement therapy in the treatment of acute kidney injury in infants with congenital heart disease after surgery

目的比较持续腹膜透析和持续血液滤过治疗在先天性心脏病手术后婴幼儿并发急性肾功能损害的治疗效果。方法回顾性分析2012年1月到2013年12月间3岁以下，行先天性心脏病手术后并发急性肾功能损害婴幼儿95例的临床资料。其中，腹膜透析治疗患儿52例（腹膜透析组），持续血液滤过治疗患儿43例（血液滤过治疗组）。比较两组患儿手术后液体出超的时间（液体出量开始大于入量的时间）、乳酸恢复正常时间、术后呼吸机辅助时间、住ICU时间、术后住院时间和病死率。结果两组患儿性别、年龄、体重、疾病、手术中阻断时间和体外循环时间差异没有统计学意义。腹膜透析组液体出超的时间为（22．3±4．2）h，血液滤过治疗组为（14．2±3．6）h，组间比较，差异有统计学意义（P〈0．01）。腹膜透析组术后乳酸恢复到正常时间为（10．3±5．2）h，血液滤过治疗组为（6．8±3．4）h，组间比较，差异有统计学意义（P〈0．05）。腹膜透析组术后呼吸机辅助时间为（22．1±5．3）h较血液滤过治疗组（15．6±4．2）h明显延长，差异有统计学意义（P〈0．01）。腹膜透析组实际使用肾脏替代治疗时间为（85．4±11．7）h，血液滤过治疗组为（68．9±12．4）h，组问比较，差异有统计学意义（P〈0．05）。腹膜透析组术后住ICU时问为（8．2±3．6）d，较血液滤过治疗组（5．8±2．1）d时间长，差异有统计学意义（P〈0．05）。腹膜透析组术后住院时间为（16．2±4．4）d，血液滤过组为（15．2±3．2）d，差异没有统计学意义。结论先天性心脏病手术后婴幼儿出现急性肾功能损害，使用血液滤过治疗较腹膜透析治疗效果更好，更快，更确切。

Objective To compare the efficacies of continuous peritoneal dialysis versus continuous renal replacement therapy for acute kidney injury in infants with congenital heart disease （CHD） after surgery. Methods Retrospective analyses were performed for a total of 95 CHD infants aged under 3 years with acute renal insufficiency after operation from January 2012 to December 2013. And 52 patients received peritoneal dialysis while another 43 continuous blood purification treatment. The time until a negative balance of liquid intake and output, lactic acid recovery time, mechanical ventilation time, intensive care unit （ICU） stay length, postoperative hospitalization time and mortality were compared for two groups after operation. Results Gender, age, weight, disease, blocking time and cardiopulmonary bypass time showed no inter-group differences. The time until a negative balance of liquid intake and output in peritoneal dialysis group was 22. 3 ± 4. 2 h versus 14. 2 ± 3. 6 h in blood purification therapy group （P〈0. 01）. The lactic acid recovery in peritoneal dialysis and blood purification therapy group were 10. 3 ± 5.2 and 6. 8 ± 3. 4h respectively （P〈0. 05）. The postoperative mechanical ventilation time in peritoneal dialysis group was significantly longer than that in blood purification therapy group （22. 1 ± 5.3 vs 15.6 ± 4. 2h, P〈 0. 01）. The time of renal replacement therapy in peritoneal dialysis group was statistically longer than that in blood purification group （85.4 ± 11.7 vs 68. 9 ± 12. 4h, P〈0. 05）. ICU stay length after operation in peritoneal dialysis group was longer than blood purification therapy group （8. 2 ± 3. 6 vs 5.8 ± 2. 1 days, P〈0. 05）.Significant difference existed in postoperative hospitalization time between dialysis and blood purification groups （16. 2 ± 4. 4 vs 15. 2 ± 3. 2 days）. Conclusions The efficacy of continuous blood purification treatment is better than peritoneal dialysis in CHD infants with acute renal insufficiency after operation.