儿童维持性血液透析27例临床分析

Clinical Analysis of 27 Cases of Maintenance Hemodialysis in Children

目的探讨儿童维持性血液透析27例临床特点。方法该文便利选取该院在2017年1月—2019年12月收治的27例ESRD患儿为研究对象,所有患儿均进行MHD,其中男患儿14例,女患儿13例,年龄为2.4~14.9岁。分析患儿原发病、退出原因、透析并发症以及透析充分性等内容。结果慢性肾小球肾炎患儿为7例,占比25.93%,原因不明7例,占比25.93%。HD在开始阶段,所有患儿均选用临时中心静脉双腔管为血管通路,23例患儿成功建立了动静脉内瘘,占比85.19%。动静脉瘘组尿素清除率指数范围(1.49±0.28),尿素下降率为(71.81±9.08)%,同临时静脉双腔管组进行对比,明显效果较好,差异有统计学意义(t=6.840、6.950,P<0.05)。透析并发症主要包含高血压、低血压等,高血压发病几率最高,占比85.19%。部分患儿退出的主要原因包含多个方面:肾移植、回当地透析、死亡以及放弃治疗。结论从我国当前儿童慢性肾脏病的相关报道来看,相对较少;应及时建立ESRD儿童动静脉瘘,从而保障血液透析更加充分。

Objective To investigate the clinical characteristics of 27 children with maintenance hemodialysis.Methods In this paper,27 children with ESRD admitted to the hospital from January 2017 to December 2019 were conveniently selected as the research objects.All children underwent MHD,including 14 male children and 13 female children,age 2.4~14.9 years old.The primary disease,the reason for withdrawal,dialysis complications,and adequacy of dialysis were analyzed.Results There were 7 children with chronic glomerulonephritis,accounting for 25.93%,and 7 cases of unknown cause,accounting for 25.93%.In the initial stage of HD,all children used a temporary central venous double-lumen tube as the vascular access,and 23 children successfully established an arteriovenous fistula,accounting for 85.19%.The urea clearance index range of the arteriovenous fistula group was(1.49±0.28),and the urea reduction rate was(71.81±9.08)%.Compared with the temporary venous double-lumen tube group,the effect was significantly better,the difference was statistically significant(t=6.840,6.950,P<0.05).Dialysis complications mainly include hypertension,hypotension,etc.The incidence of hypertension was the highest,accounting for 85.19%.The main reasons for the withdrawal of some children include multiple aspects:kidney transplantation,returning to the local area for dialysis,death and giving up treatment.Conclusion From the current reports of chronic kidney disease in children in my country,there are relatively few reports;arteriovenous fistulas in children with ESRD should be established in time to ensure more adequate hemodialysis.