小儿急性血液透析临床分析

目的 探讨血液透析小儿急性肾功能衰竭及药物、毒物中毒中治疗的临床意义和影响疗效的因素。方法 对40例10个月－14岁急性危重肾功能及药物、毒物中毒患儿140例次血液透析进行分析。结果 痊愈、好转占24例（60.0%），主要并发症为低钾血症（61.9%）、失衡综合征（13.6%）、低血压（10.0%）和出血（7.8%）。疾病转归与首次透析时尿素氮、肌酐无相关性。结论 血液透析是抢救小儿急性肾功能衰竭的安全有效的方法，疗效与原发病、治疗时机和并发症的严重程度有关。     

小儿血液透析应用特点和临床分析

探讨血液透析（HD）在儿科应用的特点及小儿肾功能衰竭HD的临床意义。方法对20例1a～14a危重肾功能衰竭及药物中毒患儿进行67次HD分析。结果所有病例在HD后肾功能明显改善,尿毒症症状减轻。痊愈、好转各6例,自动出院、死亡各4例,无1例死亡与透析直接有关。主要并发症为失衡综合征（11．9％）和低血压（10．5％）。结论HD成功的关键在于血管通路的建立、血容量的稳定及并发症的防治。HD抢救危重肾功能衰竭患儿疗效迅速、安全、可靠。     

小儿血液透析和滤过的特点及指征

目的 探讨小儿血液透析（HD）及血液透析并滤过（HDE）的特点及指征。方法 采用预防性透析，对31例因各种原因导致的肾功能衰竭、药物或毒物中毒及多器官功能障碍综合征（MODS）的患儿进行了99例次的HD及9例次的HDF。结果 肾功能恢复正常22例，好转7例，死亡2例。并发症少，其中低血压9．17％，失衡综合征2．75％。结论 小儿HD及HDF成功的关键是要遵循小儿生理特点，考虑透析指征，根据尿素清除率与血流速度曲线调节血流量及时间，并对急性肾功能衰竭进行预防性透析，对高度水肿、尿毒表现严重、血液动力学不稳定及MODS儿行HDF。     

小儿急性肺损伤和急性呼吸窘迫综合征15例临床分析

小儿急性肺损伤（ＡＬＩ）和急性呼吸窘迫综合征（ＡＲＤＳ）的报告较少,为了解其在危重患儿中的发病情况,现将我院ＰＩＣＵ１９９６年２月至１９９８年１月发生的６例ＡＬＩ和９例ＡＲＤＳ报告如下。１　资料与方法１－１　诊断标准　本文病例按１９９４年欧美ＡＲＤＳ联席会议的标准诊断ＡＬＩ和ＡＲＤＳ［１］,按Ｓａｅｚｌｉｏｒｅｎｓ和ＭｃＣｒａｃｋｅｎ的标准诊断小儿全身性炎症反应综合征（ＳＩＲＳ）［２］,按１９９５年太原会议制订的“小儿危重病例评分法及小儿系统脏器功能衰竭的诊断标准”诊断脏器功能衰竭［３］。１－…     

小儿慢性粒细胞性白血病11例临床分析

小儿慢性粒细胞性白血病（ＣＭＬ）是儿童时期少见的白血病类型。我院从１９８２年至１９９７年期间共收治１１例小儿ＣＭＬ,现分析报道如下：一、临床资料１．一般情况：我院从１９８２年至１９９７年１５年间共收治小儿ＣＭＬ１１例,其中男８例;女３例,男女之比为２．６７：１。年龄最小为１岁１１月;最大为１３岁。慢性期９例,占８１．８％,加速期与急变期各１例。成人型１０例,占９０．９％,婴儿型１例。２．临床表现：１１例小儿ＣＭＬ均有不同程度的贫血和肝脾肿大。最重的１例贫血Ｈｂ为３０ｇ／Ｌ。肝脾肿大以牌大为主,轻…     

小儿维持性血液透析1例报告

随着血液净化技术不断完善,终末期肾脏病（ESRD）患者仍以腹膜透析（PD）和血液透析（HD）为主要治疗手段,尤其是小儿急、慢性肾功衰竭以往仍首选PD,小儿HD难度较大在于血管通路的建立及水份、营养的管理。我院于1975年将HD应用于临床,已经对几十例药物、毒物导致急性肾功能衰竭（ARF）患儿进行HD治疗,效果显著,现将1例典型病例报告如下。     

血液透析治疗小儿急性肾功能衰竭61例次报告

目的 研究血液透析（HD）治疗小儿急性肾功能衰竭（ARF）的特点及其方法。方法 对22例患儿61次HD的策略、HD前后血尿素氮、肌酐、电解质水平监测，HD的并发症及处理、抗凝及血管通道建立等进行观察和分析。结果 HD疗效满意。痊愈17例，好转5例。HD的主要并发症为低血压（20．2％）。结论 HD能减少ARF并发症的发生，促使肾功能较快恢复，降低病死率。掌握小儿HD的特点及方法是透析成功的关键。     

小儿伤寒多系统损害84例分析

小儿伤寒多系统损害８４例分析苏州市吴县红十字医院（２１５１２８）周琳我院１９９０～１９９年共收治小儿伤寒１４７例，发生多系统损害８４例（占５７．１％），８４例中，并发１个系统损害者４１例（占４８．８％），２个系统损害者３３例（占３９．３％），≥３个系...     

小儿双腔右心室的诊断：附23例临床分析

总结１９９１年１月－１９９３年１２月，安贞医院小儿心脏科经手术证实的双腔右心室２３例，其中单纯型１例，复合型２２例。术前诊断符合率为９１．３％（２１／２３例），仅２例（占８．７％）误诊。认为对超声心动图诊断室间隔缺损的患儿，如有以下临床特征；（１）胸骨左上缘有收缩期震颤及杂音；（２）肺动脉瓣第二心音减弱；（３）胸部Ｘ线检查肺动脉段凹陷；（４）心电图Ｔｖ１，Ｔｖ３Ｒ直立（占８２．６％）。再配合重复细     

230例小儿脓胸的治疗体会

２３０例小儿脓胸的治疗体会徐振海，傅松本院１９８９年２月～１９９２年４月收治小儿脓胸２３０例，９６．５％来自农村，肺炎后脓胸为最多（２２６例）。病史短于１周者占１９．１％，大于２周者３８．７％，最长１年。治疗方法：患儿入院后即给予两种抗生素加一种抗厌...     

End-stage renal insufficiency in children less than 4 months old. Survey of the French Pediatric Nephrology Club

One hundred and eleven cases of children with end-stage renal failure prior to 4 years of age were collected from a survey of the French Pediatric Nephrology Club. Clinical and epidemiological data stress the importance of certain etiologies such as 40 cases of renal hypoplasia. The necessity of planning extracorporeal dialysis from the first year of life in 37% of patients demonstrates the importance of difficulties to be overcome. The treatments used for the 82 treated children show the interest of conservative management. However, peritoneal dialysis remains the first treatment of choice (52 times). Besides the problems of hemodialysis vascular approach, related to the small caliber of vessels, the complications of the clearance techniques did not appear to be more frequent than in older children. Use of transplantation is not negligible as 25% of transplanted patients were under 4 years of age; however none was under one year or weighted less than 8 kg. Transplantation remains ultimate treatment, even more so as the actuarial survival at 5 years is clearly worse for children submitted to hemodialysis (68%) than to transplantation (91%) (p less than 0.05).     

血液透析治疗小儿急性肾功能衰竭61例次报告

目的　 研究血液透析 (HD)治疗小儿急性肾功能衰竭 (ARF)的特点及其方法。 方法 　对 2 2例患儿 61次HD的策略、HD前后血尿素氮、肌酐、电解质水平监测 ,HD的并发症及处理、抗凝及血管通道建立等进行观察和分析。 结果 　HD疗效满意。痊愈 17例 ,好转 5例。HD的主要并发症为低血压 ( 2 0 2 % )。 结论 　HD能减少ARF并发症的发生 ,促使肾功能较快恢复 ,降低病死率。掌握小儿HD的特点及方法是透析成功的关键。     

Hemolytic-uremic Syndrome: An Analysis of the Natural History and Prognostic Features

Sixty-seven children with hemolytic-uremic syndrome (HUS) were admitted between 1974 and 1981. Of these, 52 (78 %) were aged less than 3 years. All children had acute renal failure and 48 (72 %) required peritoneal dialysis. The etiology in twenty cases varied from bacterial and viral infections (7 and 5 cases, respectively) to renal irradiation with chemotherapy (2) and preexisting glomerulopathy (1). 5 (7 %) children died during the acute phase of the illness. Long-term follow-up (mean 3 years 3 months) of 56 cases showed that 37 children (60 %) had so far experienced no functional sequelae and 8 (13 %) only mild sequelae while 3 (5%) were on iterative hemodialysis, 3 had severe chronic renal failure and high blood pressure (HBP) and 5 (8 %) had HBP and normal kidney function. While the recovery rate was approximately 60 % in all age groups, the mortality rate and serious after-effects were twice as frequent (42 %) in children over 3 years of age as in those less than 3. Renal histology (total of 37) showed 12 cases of cortical necrosis, 22 of glomerular thrombotic microangiopathy (TMA) and 3 arterial TMA. Prognosis was poor for all cases of arterial TMA and 58 % of those exhibiting cortical necrosis.     

Hemolytic-uremic syndrome: an analysis of the natural history and prognostic features

Sixty-seven children with hemolytic-uremic syndrome (HUS) were admitted between 1974 and 1981. Of these, 52 (78%) were aged less than 3 years. All children had acute renal failure and 48 (72%) required peritoneal dialysis. The etiology in twenty cases varied from bacterial and viral infections (7 and 5 cases, respectively) to renal irradiation with chemotherapy (2) and preexisting glomerulopathy (1). 5 (7%) children died during the acute phase of the illness. Long-term follow-up (mean 3 years 3 months) of 56 cases showed that 37 children (60%) had so far experienced no functional sequelae and 8 (13%) only mild sequelae while 3 (5%) were on iterative hemodialysis, 3 had severe chronic renal failure and high blood pressure (HBP) and 5 (8%) had HBP and normal kidney function. While the recovery rate was approximately 60% in all age groups, the mortality rate and serious after-effects were twice as frequent (42%) in children over 3 years of age as in those less than 3. Renal histology (total of 37) showed 12 cases of cortical necrosis, 22 of glomerular thrombotic microangiopathy (TMA) and 3 arterial TMA. Prognosis was poor for all cases of arterial TMA and 58% of those exhibiting cortical necrosis.     

血浆置换术后联合小剂量激素治疗溶血尿毒综合征

目的探讨血浆置换术后联合小剂量激素治疗溶血尿毒综合征(HUS)的疗效。方法回顾性分析近5 a来本院肾内科11例HUS患儿临床资料。男6例,女5例;年龄2～9岁,平均年龄5.2岁。重症10例,轻症1例。其中8例进行血浆置换治疗,每例2、3次,术后应用泼尼松(1.0～1.5 mg.kg-1)或甲泼尼龙(1 mg.kg-1)维持;其中1例联合血液透析治疗,1例联合连续性血液滤过治疗。轻症1例采用大剂量丙种球蛋白(丙球)治疗。1例重症HUS外院进行血液透析1个月余转本院继续血液透析治疗。1例重症HUS外院采用大剂量丙球冲击联合甲泼尼龙治疗后继续甲泼尼龙1 mg.kg-1治疗和肠道透析。结果 19例次血浆置换治疗均顺利实施,无明显并发症;8例血浆置换后联合小剂量激素治疗者中7例肝酶、心肌酶、肾功能恢复正常,尿常规镜下血尿或并轻中度蛋白尿出院,追踪观察2～26个月,复查肾功能均正常,尿蛋白阴性,5例镜下轻微血尿[RBC(9～36)×106L-1],1例感染后轻微镜下血尿,1例尿常规正常。轻症1例出院时尿常规和肾功能均正常,门诊随诊38个月尿常规正常。2例外院治疗的重症HUS患儿转入本科时病程1周～1个月,血小板已恢复正常,Hb无继续下降,尿常规示肉眼血尿和中量蛋白尿,处于肾衰竭期。其中1例血液透析6次,肾功能稍好转、肉眼血尿并中量蛋白尿,放弃治疗出院。1例经肠道透析和口服激素等措施后放弃治疗出院。结论重症HUS患儿宜早期应用血浆置换治疗,血浆置换治疗后联合小剂量激素治疗可改善重症HUS患儿预后,减少后遗症。     

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??Objective??To study the current status of common blood purification therapy for childhood-onset severe systemic lupus erythematosus??SLE?? in China. Methods??The questionnaire was discussed and set by Pediatric Blood Purification Specialist Committee??the data of 127 hospitalized children with blood purification therapy in 22 units were collected and analyzed from January 1??2012 to December 31??2017. Results????1??Among the 127 cases??including 28 males and 99 females??between 4 to 16 years old. 63 cases were treated by plasma exchange??PE?? for 180 times??41 cases were treated by DNA immunoadsorption??DNA-IAS?? for 106 times??11 cases were treated by hemodialysis??HD?? for 112 times??12 cases were treated by hemoperfusion??HP?? for 32 times. ??2??PE and DNA-IAS can alleviate the clinical symptoms effectively??causing the systemic lupus erythematosus disease activity index??SLEDAI????ANA titer??antidouble-stranded DNA antibodies??immunoglobulin to decrease and complement to increase significantly. HD for children with renal insufficiency was effective??HP can eliminate inflammatory factors and relieve clinical symptoms of children. The remission rates of PE??DNA-IAS??HD and HP were 87.30%??87.80%??72.73% and 75.00% respectively. Conclusion??PE and DNA-IAS therapy can remove the immune substances in the blood of children with severe SLE quickly and relieve the disease??HD therapy is mainly used for children with severe edema and renal insufficiency??HP therapy can eliminate inflammatory factors effectively and improve clinical symptoms. For children with severe SLE??different blood purification mode should be selected according to the difference of the children’s condition.     

Evaluation of new markers of bone metabolism in renal osteodystrophy in children

Serum intact parathormone (PTH 1.84) and osteocalcin levels were evaluated as early markers for secondary hyperparathyroidism in a group of pediatric patient treated with chronic hemodialysis. PTH 1.84 levels which were more closely related with alkaline phosphatase levels than PTH 53.84 levels, allowed to identify a group of children without biologic or roentgenographic evidence of hyperparathyroidism and with a normal residual hormone level. PTH 1.84 levels seem to be a reliable indicator of parathormone secretion than conventional assays and may be used as a routine test for monitoring children under chronic hemodialysis. Conversely, the plasma osteocalcin level measured by radioimmunoassay was increased in all studied patients regardless of parathyroid status and seemed to be of little value for monitoring renal osteodystrophia. Lumbar vertebral plate bone density studies disclosed abnormalities of bone mineralization in half the children with renal failure. Dialyzed or non dialyzed. Patients with decreased bone mineralization presented, in most of cases, a history of previous steroid treatment. A group of children with very severe renal failure had increased bone mineralization. The interpretation of this abnormality remains to be determined.     

91所医院1990～2002年小儿慢性肾衰竭1268例调查报告

目的　调查我国 1990年 1月～ 2 0 0 2年 12月间 0～ 14岁住院小儿中慢性肾衰竭 (CRF)病例的年龄、病因、临床病理特点、治疗情况及转归。方法　由中华医学会儿科学分会肾脏病学组统一组织领导 ,全国 4个直辖市、13个省及 2个自治区共 91所医院参加调查。CRF诊断以内生肌酐清除率 (CCr) <5 0ml/(min·1 73m2 )为标准。采用填写调查表形式 ,对诊断为慢性肾衰竭的住院患儿进行回顾性病例登记 ,进行相关资料统一汇总、分析。结果　 1990年 1月～ 2 0 0 2年 12月间 ,91所医院0～ 14岁住院小儿中共诊断CRF 16 5 8例 ,每年在住院的泌尿系统疾病患儿中所占比例为 0 72 %～1 75 % ,平均 1 31% ,呈逐渐上升趋势。 1997～ 2 0 0 2年与 1990～ 1996年比较 ,CRF平均年诊断例数和占泌尿系统疾病的百分数均显著增加 (P <0 0 0 1)。 12 6 8例完整资料分析显示 :男女比例 1 4 9∶1,平均发病年龄 8 2岁 ,平均确诊前病程 2 5年。主要原发病为慢性肾炎和肾病综合征 ,占 5 2 7% ,先天 /遗传性疾病约 1/4,以肾发育异常和肾囊性病为主。确诊时主要临床表现为贫血、胃肠反应、水肿、高血压和体格发育落后 ;平均血清肌酐 (SCr) 5 94 7μmol/L ,BUN 39 1mmol/L ,肾功能分级≥Ⅳ级者占 80 % ;1/3有肾萎缩 ,部分见囊性病变。多