腹膜透析在心脏手术后急性肾功能衰竭治疗中的应用

心脏病患者手术前常有不同程度的肾功能不全，手术创伤及体外循环的打击可导致术后出现急性肾功能衰竭(肾衰)。我院自1999年4月～2003年6月因术后早期出现急性肾衰行腹膜透析治疗患者33例，占同期手术总数的0．80％(33／4139)，现报告如下。     

腹膜透析治疗小儿心脏手术后并发急性肾功能衰竭

目的总结腹膜透析（PD）治疗小儿心脏手术后并发急性肾功能衰竭（ARF）的临床经验。方法27例ARF患者，年龄3个月～12岁（4．20±3．58岁）；体重4．2～30．0kg（12．35±7．65kg）。因心脏手术后发生ARF进行PD。动态监测血气分析、电解质、血清肌酐（Cr）、尿素氮（BUN）、平均动脉压（MAP）和中心静脉压（CVP）的变化。结果PD后5d Cr、BUN与PD前比较明显下降（P〈0．01），血钾、血钠、碳酸氢根（HCO3^-）恢复正常。术后死亡8例（29．6％），死于低心排血量3例，感染并发多器官功能衰竭3例，恶性心律失常1例，肺动脉高压危象1例。发生并发症9例（33．3％），其中管周漏液3例，腹膜炎3例，透析管堵塞3例（其中感染堵塞1例、大网膜堵塞2例）。结论小儿心脏手术后ARF早期行PD疗效肯定、安全，操作方便，可降低死亡率。     

腹膜透析治疗幼儿烧伤后伴急性肾功能衰竭一例

幼儿急性肾功能衰竭后行腹膜透析临床上少见，我们收治了1例烧伤后并发急性肾衰的患儿，进行腹透治疗，预后良好。     

小儿先天性心脏病手术后腹膜透析治疗

目的　探讨腹膜透析治疗小儿心脏直视手术后急性肾功能不全和充血性心力衰竭的疗效。　方法　对6 1例患者术后应用间歇性腹膜透析治疗 ,并记录和监测循环、代谢指标。　结果　几乎所有病例都能超滤出多余的水分 ,存活 4 4例经腹膜透析 1～ 4天后尿量恢复正常 ,超滤出液体 32± 11ml· kg- 1 /d,中心静脉压、血清乳酸、肌酐均下降 ,酸中毒、高血钾、低氧血症和低心排血量综合征被纠正 ,出院时心、肾功能均正常。全组死亡 17例 ,无死于腹膜透析并发症者。　结论　小儿心脏手术后如出现钠水潴留或急性肾功能不全 ,难以排出多余的水分 ,宜尽早开始腹膜透析 ,纠正钠、水潴留 ,恢复内环境平衡 ,减轻心脏负担 ,可明显改善心、肾功能 ,而且方法简便、经济、安全。     

心脏术后急性肾功能衰竭

急性肾功能是心脏术后常见而严重的并发症，是患者死亡率增加的独立危险因素，探讨心脏术后发生ARF的危险因素，并积极预防和治疗是近年来研究的热点之一，本文就心脏术后发生急性肾功能衰竭的相关因素、治疗和预后等问题的临床研究进展作一综述。     

高龄肾功能衰竭患者腹膜透析疗效分析

目的：评价腹膜透析（PD）在高龄肾功能衰竭患者治疗中的作用。方法：观察35例高龄有功能衰竭患者PD治疗前后肾功能，肝功能，血红蛋白等评价指标的动态变化，并发症的发生情况及生存率的变化。结果：大多数高龄患者在行PD治疗后，尽管血尿素氮，肌酐有明显降低，但血浆白蛋白，血清前白蛋白和血红蛋白等全身营养状况指标均较治疗前亦有明显下降，常见并发症有：低血钾，腹膜炎，呼吸道感染，心力衰竭，皮肤和肢体末端溃疡和腹壁疝，结论：PD治疗并非是高龄肾功能衰竭患者最合适的治疗手段，应综合考虑患者病情，选择适合的透析方式。     

腹膜透析在小儿心脏手术后急性肾功能不全中的应用

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妇。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〈1ml/kg，持续4h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（Or）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〉6d者较PD≤6d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。     

腹膜透析治疗小儿重度烧伤早期并发急性肾功能衰竭六例

重度烧伤早期并发急性肾功能衰竭 ,是威胁生命的并发症之一 ,死亡率较高。 97年以来笔者应用腹膜透析 (ＰＤ)疗法 ,治疗 6例烧伤早期并发急性肾功能衰竭的儿童 ,效果满意。资　料　与　方　法1.一般资料 :本组 6例 ,其中男 4例、女 2例 ,年龄 1.4～3.2岁 ,平均 2 .2 5岁。烧伤部位分布于头面部、四肢、会阴部、后躯干及臀部等。烧伤总面积在 2 0 %～ 45 % ,平均(30 7± 9 5 ) %ＴＢＳＡ。深Ⅱ度～Ⅲ度面积约 8%～ 14% ,平均 (10 3± 2 .5 ) %ＴＢＳＡ。 6ｈ内入院 2例 ,2 4ｈ内入院 4例 ,平均 16ｈ。入院时询问病史 ,少尿 5例 ,尿量正常 1…     

高容量血液滤过治疗心脏手术后急性肾功能衰竭

目的探讨高容量血液滤过(HVHF)对心脏手术后急性肾功能衰竭的治疗效果。方法对11例心脏手术后并发急性肾功能衰竭的患者行HVHF治疗,观察治疗前、治疗结束时的心率、平均动脉压、肾功能、动脉血气和电解质的变化;记录治疗前、治疗后24h4、8h、72h和96h去甲肾上腺素、肾上腺素的用量情况。结果经HVHF治疗后心率明显减慢(P<0.01),平均动脉压显著上升(P<0.01),血肌酐、尿素氮、尿酸水平均显著下降(P<0.01),动脉血氧分压明显升高(P<0.01),血钾明显降低(P<0.01);治疗后的24h、48h、72h和96h去甲肾上腺素、肾上腺素的剂量逐渐减少,血压逐渐上升(P<0.05)。结论HVHF是治疗心脏手术后急性肾功能衰竭的有效方法。     

心脏术后低排综合征致急性肾功能衰竭的腹膜透析治疗

目的　探讨腹膜透析对心脏术后低排综合征 (LOS)致急性肾功能衰竭 (ARF)的疗效。方法　 2 4例心脏术后引起LOS合并多脏器功能衰竭 (MSOF)致ARF者 ,因不适合血液透析 (HD) ,于确诊后 2 4小时内进行腹膜透析 (PD)治疗。结果　 12例患者多脏器严重衰竭死亡 ,9例患者PD 3～30天内肾功能恢复 ,3例治疗后病情好转 ,自动出院。结论　心脏术后LOS致MOSF合并有ARF者 ,PD具有较好的治疗效果。     

Peritoneal dialysis in acute renal failure

The definition of adequate dialysis in acute renal failure (ARF) is complex and involves the time of referral to dialysis, dose, and dialytic method. Nephrologist experience with a specific procedure and the availability of different dialysis modalities play an important role in these choices. There is no consensus in literature on the best method or ideal dialysis dose in ARF. Peritoneal dialysis (PD) is used less and less in ARF patients, and is being replaced by continuous venovenous therapies. However, it should not be discarded as a worthless therapeutic option for ARF patients. PD offers several advantages over hemodialysis, such as its technical simplicity, excellent cardiovascular tolerance, absence of an extracorporeal circuit, lack of bleeding risk, and low risk of hydro-electrolyte imbalance. PD also has some limitations, though: it needs an intact peritoneal cavity, carries risks of peritoneal infection and protein losses, and has an overall lower effectiveness. Because daily solute clearance is lower with PD than with daily HD, there have been concerns that PD cannot control uremia in ARF patients. Controversies exist concerning its use in patients with severe hypercatabolism; in these cases, daily hemodialysis or continuous venovenous therapy have been preferred. There is little literature on PD in ARF patients, and what exists does not address fundamental parameters such as adequate quantification of dialysis and patient catabolism. Given these limitations, there is a pressing need to re-evaluate the adequacy of PD in ARF using accepted standards. Therefore, new studies should be undertaken to resolve these problems.     

Peritoneal dialysis for acute renal failure in children

Fifty infants and children with acute renal failure were treated with acute peritoneal dialysis between 1987 and 1990. The patients were dialyzed using either a catheter introduced percutaneously over a guide-wire (n=40) or a Tenckhoff catheter (n=10). The cause of the acute renal failure was primary renal disease in 17 children, cardiac disease in 19, and trauma/sepsis in 14. Peritoneal dialysis succeeded in controlling metabolic abnormalities, improving fluid balance, and relieving the complications of uremia. The procedure had few major complications. Overall mortality was 50%, reflecting the serious nature of the underlying diseases. We conclude that acute peritoneal dialysis is a safe and effective treatment in most pediatric patients with acute renal failure. Our series of patients treated with acute peritoneal dialysis serves as a basis of comparison for the evaluation of new modalities of therapy in childhood acute renal failure.     

Peritoneal dialysis for chronic renal failure in a patient with methylmalonic acidaemia

Chronic renal failure is a common complication of methylmalonic acidaemia (MMA). It is usually managed with haemodialysis and renal transplantation. We report the use of continuous cycling peritoneal dialysis (CCPD) for 20 months in a paediatric patient with chronic renal failure due to MMA. This procedure resulted in the elimination of 950 μmol methylmalonate (MM) per day and a fall in the plasma MM concentration from 3.9 to 0.74 mmol/l. As a result of this treatment, the frequency at which this patient was hospitalised was markedly reduced prior to a successful renal transplantation.     

Peritoneal dialysis in patients with heart failure

Both in dialysis patients and non-uremic patients heart failure is associated with an adverse prognosis. In a state of abrupt worsening of cardiac function, acute cardiogenic shock or decompensated congestive heart failure, acute kidney injury may occur, whereas in a more chronic worsening of cardiac function chronic kidney injury may occur. Recently, the term cardiorenal syndrome was adopted and defined as "a pathophysiological disorder of the heart and kidneys whereby acute or chronic dysfunction in one organ may induce acute or chronic dysfunction in the other organ". Despite better treatment techniques and the continuous development of new medications volume overload in patients with cardiorenal syndrome is difficult to treat. Especially treatment of cardiorenal syndrome type I and II is notoriously difficult. Peritoneal dialysis might be, because of the gradual fluid removal, a therapeutic option in these patients. However, data on the effect of peritoneal dialysis in patients with heart failure with fluid overload and/or renal impairment are scarce. In this reviewe, the role of peritoneal dialysis in the treatment cardiorenal syndrome type I, II and IV will be discussed.