腹膜透析治疗早产儿急性肾功能衰竭的临床分析

Peritoneal dialysis for acute renal failure in premature infants

目的探讨腹膜透析治疗早产儿急性。肾功能衰竭（acuterenalfailure，ARF）的有效性和安全性。方法2012年3月至2015年3月，在广东省妇幼保健院新生儿重症监护病房住院的ARF早产儿中，12例进行腹膜透析。采用连续性腹膜透析的方法，透析液不加入抗生素。比较透析前后血清尿素氮、肌酐、血钾和pH的变化。观察堵管、渗漏、感染、新生儿坏死性小肠结肠炎等并发症情况，以及胃肠内营养建立情况。透析前后指标比较采用配对设计资料的Wilcoxon符号秩和检验。结果12例ARF早产儿中，9例为败血症，2例为窒息，1例为双胎输血综合征。12例患儿的平均出生胎龄为（30．9±3．2）周，透析前体重为（1461±525）g，持续透析天数为（3．8±2．6）d。3例出现置管处渗漏。2例发生腹膜炎，腹水培养分别为白色念珠菌和肺炎克雷伯菌感染。6例患儿于腹膜透析结束后1～4d建立胃肠内营养，其中1例喂养7d后出现坏死性小肠结肠炎。共有4例患儿治愈出院，6例因家属放弃治疗后死亡，2例因原发病严重而死亡。12例患儿透析前与透析后血尿素氮平均值分别为（12．71±6．98）与（9．16±3．15）mmol／L，血钾分别为（6．24±1．72）与（4．36±0．82）mmol／L，pH分别为7．21±0．17与7．32±0．17；透析后血尿素氮和血钾水平降低，pH值升高，差异均有统计学意义（z值分别为-2．118、-2．197和-2．981，P值均〈0．05）。结论腹膜透析治疗早产儿ARF安全有效，且操作及所需设备较为简单，可用于。肾脏替代治疗。

Objective To investigate the effectiveness and safety of peritoneal dialysis（PD） in premature infants with acute renal failure（ARF）. Methods In the neonatal intensive care unit （NICU） of Guangdong Province Maternal and Children Hospital, 12 premature infants underwent continuous PD due to ARF from March 2012 to March 2015, without using any antibiotics in the dialysis fluid. Before and after dialysis, the changes of serum urea nitrogen, creatinine, potassium and pH were compared. The complications （blockage, leakage, infection and necrotizing enterocolitis） and gastrointestinal nutrition situation were observed. Wilcoxon signed rank sum test was used for statistical analysis. Results Among the 12 premature infants, the underlying causes of ARF were sepsis （n=9）, perinatal asphyxia （n=2）, twin-twin transfusion syndrome （n=l）. The average gestational age was （30.9_ 3.2） weeks, the average body weight （before PD） was （1 461 ± 525） g, the duration of PD was （3.8 ±2.6） d. Complications associated with PD included leakage （n=3） and peritonitis （n=2） in which Candids albicans and Klebsiella pneumonia were identified in ascites. Gastrointestinal nutrition was built up in six cases within one to four days after dialysis, among which one developing necrotizing enterocolitis on the 7th d after feeding. Finally, eight babies died （six died after initiative discontinued treatment and two died because of critically illness） and four patients were cured and discharged. Lower serum urea nitrogen and potassium levels and higher pH value were shown after dialysis than before [（9.16± 3.15） vs （12.71±6.98） mmol/L; （4.36±0.82） vs （6.24± 1.72） mmol/L; 7.32±0.17 vs 7.21 ±0.17; Z= - 2.118, - 2.197and - 2.981, all P 〈 0.05）. Conclusion PD is an alternative safe and effective treatment for premature infants with ARF due to its simplicity both in manipulation and equipment requirement.