摘要
目的评价腹膜透析(PD)对小儿心脏术后急性肾功能不全(ARF)的疗效。方法 1999年10月至2005年10月行先天性心脏病术后符合 ARF 诊断的病儿63例,男49例,女14例。年龄0.12～14岁;体重3.5～35.0 kg。体外循环下行根治手术52例,姑息手术11例。对术后持续少尿(每小时尿量<1 ml/kg,持续4 h 以上),经液量限制、利尿剂及正性肌力药物联合治疗无效;或血清肌酐浓度(Cr)增高并出现持续代谢性酸中毒,高钾血症(>5.5mmol/L),容量超负荷,低心排出量综合征(低心排)等任一种情况者予以腹膜透析。记录 PD 开始时间、持续日程以及尿量恢复时间。动态测定血清肌酐。结果术后均合并多器官功能障碍,共施行腹膜透析58例(92.1%),PD 病儿主动脉阻断时间显著延长(P<0.01);手术难度分级明显增高(P<0.05);血清肌酐下降、恢复时间以及尿量恢复时间明显延后(P<0.05)。PD>6 d 者较 PD≤6 d 者手术复杂程度明显增高,血清肌酐出现峰值、下降、恢复的时间较晚(P<0.05),尿量恢复时间明显延后(P<0.05);低心排持续时间和多器官功能障碍累及的器官数量分别为 PD≤6者的1.74倍和1.26倍,插管以及监护室时间显著延长(P<0.05)。PD 后生存者肾功能恢复率100%,恢复值与基础值相比差异无统计学意义(P>0.05)。死亡原因包括:严重低心排15例(71.4%),多器官功能障碍2例(9.5%),败血症2例(9.5%),呼吸衰竭1例(4.8%),脑损害1例(4.8%)。结论 PD 治疗小儿心脏术后 ARF 效果良好,并发症少。PD 时间延长与复杂先心病手术,术后较高的血清肌酐浓度及其到达峰值、下降、恢复时间的延后,尿量恢复晚,低心排持续时间长,功能障碍的累及器官多,以及插管、监护时间延长等围术期因素密切相关。
Objective The aim of this study is to evaluate the efficiency of peritoneal dialysis （PD） for the treatment of acute renal failure（ARF） in children followingopen-heart surgery. Methods The clinical reenrds of 63 conseentive cases [raean age （3.60± 3.67） years, mean weight （ 13.45 ± 7.68） kg], of ARF after cardiac surgery for cengenital heart defects between October 1999 and October 2005 were reviewd. Indications for PD included oliguria for more than 4 hours despite medication interventions or, in the absence of established oliguria, increased creatinine level in association with one of the followings： clinical sights of fluid overload, hyperkalemia （ 〉 5.5mmol/L）, persistent metabolic acidosis, or low cardiac output syndrome. Following data were collected in all patients： time to initiation and duration of PD; time point of the recovery of urine output; baseline serum creatinine level （Cr0）, rise of Cr （Cr1） ,peak Cr （Cr2）, descending Cr （Cr3）, recovery of Cr （Cr4） ; and their corresponding postoperative time points, Results Of the 63 pationts, 58 （92.1%） required PD. Overall mortality rate was 33.3% （21163）. Patients undergone more complex surgery requiring longer aortic clamping time; have higher Cr0, Cr2, Cr3 and longer period of the recovery of Cr and urine output （ P 〈0.03, P 〈 0.01 ） more likely required PD. Prolonged PD （PD〉 6d） was associated with mere complicated surgical procedure, higher Cr1 and Cr2, delayed recovery of Cr and urine output after surgery, longer period of low cardiac output syndrome, more dysfunctional organs, longer mechanical ventilation and 1CU stay postoperatively （ P 〈 0.05, P 〈 0.01）. Peritoneal dialysis was proved effective and safe in improving renal function in all survivors. Conclusion Risk factors for PD in children undergoing open heart surgery are complex operation, longer aortic clamping duration, and mere severe ARF with delayed recovery of serum creatinine level and urine output. The postopera
出处
《中华胸心血管外科杂志》
CSCD
北大核心
2007年第4期224-227,共4页
Chinese Journal of Thoracic and Cardiovascular Surgery
关键词
肾功能不全
急性
腹膜透析
心脏外科手术
儿童
Kidney failure, acute Peritoneal Dialysis Cardiac Surgical procedure Child
