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目的探讨腹膜透析(PD)治疗小儿心脏病术后合并急性肾损伤(AKI)的临床疗效。方法回顾性分析2009~2013年海南省农垦总医院收治的20例先天性心脏病矫治术后并发AKI患儿的临床资料,总结腹膜透析治疗的临床疗效、并发症及预后情况。结果 20例患儿中3例死亡(15.0%),余17例患儿经积极早期PD治疗后尿量在22~120 h后恢复正常,治疗72 h后患儿肾功能血Cr、BUN、血钾水平均较PD前明显降低,碳酸氢根浓度明显升高,差异均有统计学意义(P<0.05)。患儿透析期间出现透析管周围渗漏2例(11.8%),术后随访1年,17例存活患儿的肾功能均完全恢复正常。结论 PD是治疗小儿心脏术后合并AKI的有效方法,并可以有效控制液体平衡,纠正高钾血症及代谢性酸中毒。
Objective To investigate the clinical efficacy of peritoneal dialysis (PD) in the treatment of acute kidney injury (AKI) after pediatric heart disease. Methods The clinical data of 20 children with AKI complicated with congenital heart disease admitted from Hainan Provincial Land Reclamation General Hospital from 2009 to 2013 were retrospectively analyzed. The clinical efficacy, complications and prognosis of peritoneal dialysis were summarized. Results Of the 20 children, 3 died (15.0%). The remaining 17 children returned to normal after 22 ~ 120 h after active early PD treatment. After 72 hours of treatment, renal function blood Cr, BUN, blood Potassium levels were significantly lower than before PD, bicarbonate concentration was significantly increased, the difference was statistically significant (P <0.05). There were 2 cases (11.8%) of leaking around the dialysis tube during dialysis, and the renal function of 17 surviving children recovered completely after 1 year follow-up. Conclusion PD is an effective method for the treatment of children with AKI after cardiac surgery, and can effectively control the fluid balance and correct hyperkalemia and metabolic acidosis.