应用RIFLE标准观察腹膜透析在儿童急性肾损伤中的治疗效果

RIFLE in assessment of therapeutic effects of peritoneal dialysis for acute kidney injury in children

目的应用危险-伤害-衰竭-肾功能丧失-晚期肾衰竭(Risk,Injury,Failure,Loss,and End-stage Renal Failure,RIFLE)标准观察腹膜透析(PD)在治疗不同时期急性肾损伤(AKI)儿童患者中的效果。方法回顾性分析应用PD治疗的40例儿童AKI患者的临床资料,采用RIFLE标准,将患者分为AKI 1期、AKI 2期和AKI 3期三组,分析对比各组患者行PD治疗前后临床参数,包括血尿素氮(BUN)、血清肌酐(Cr)、钾离子(K+)、二氧化碳结合力(CO2CP)等水平的变化;对各组间ICU住院时间、PD总液量、PD治疗时间进行比较。结果 40例患者中治愈20例(50.00%),死亡12例(30.00%),自动出院2例(5.00%)。其中AKI 1期治愈率高于AKI 2期、AKI 3期,与AKI 3期相比差异有统计学意义(P<0.05);AKI 3期病死率高于AKI 2期、AKI 1期,差异有统计学意义(P<0.05)。PD治疗72h后,AKI 1期、AKI 2期组患者各项临床指标改善明显(P<0.05),其中AKI 1期患者在ICU住院时间、PD总液量、PD治疗时间方面显著优于AKI 2期患者(P<0.05);AKI 3期组患者行PD治疗72h后各项指标无明显改善(P>0.05)。结论 PD在儿童患者AKI 1期和2期治疗中具有较好的效果,早期行PD治疗有助于改善儿童患者AKI的病情,采用RIFLE标准中的AKI分期对AKI早期的诊断及预后判断有指导作用。

Objective To observe the values of Risk,Injury,Failure,Loss,and End-stage Renal Failure（RIFLE）criteria in assessment of the therapeutic effects of peritoneal dialysis（PD）for children with acute kidney injury（AKI）at different stages. Methods The clinical data of 40 children with acute kidney injury treated with PD were retrospectively analyzed.The patients were divided into three groups：AKI stage 1,AKI stage 2and AKI stage 3groups by using RIFLE criteria.Clinical parameters such as blood urine nitrogen（BUN）,serum creatine（Cr）,K＋and CO2 CP levels were analytically compared before and after PD treatment among every group.The ICU duration,total volume of peritoneum dialysis and PD treatment time was compared among every group. Results Among 40 patients,20cases of them（50.00%）were cured,12cases（30.00%）died,and 2cases（5.00%）required against advice discharge from hospital.Patients of AKI stage 1had higher curative rate than patients of AKI stage 2and AKI stage 3,comparison of curative rate between AKI stage 1group and AKI stage 3group showed statistical difference（P〈0.05）,the death rate of AKI stage 3group was higher than those of AKI stage 1group and AKI stage 2group,there were statistical difference（P〈0.05）.The duration of ICU hospitalization,the total volume of fluid in PD and the PD treatment time for AKI stage 1patients were significantly better than those of AKI stage 2patients（P〈0.05）,each clinical index was not significantly improved in AKI stage 3patients after 72-hour PD treatment（P〈0.05）. Conclusion PD for children with AKI stages 1and 2has a good result,early PD treatment can help improve the condition of children with AKI.Use of the staging of AKI in RIFLE criteria can guide the early diagnosis and prognostic evaluation of AKI.