连续性静静脉血液透析滤过在儿童心脏术后急性肾衰竭中的应用

目的探讨连续性静静脉血液透析滤过（CVVHDF）对儿童心脏术后急性肾衰竭（ARF）的治疗效果。方法2004年7月至2008年7月应用PrismaTM机器行CVVHDF治疗11例心脏术后并发ARF患儿。结果11例患者开始CVVHDF治疗时的平均年龄是30.6个月（6个月～12.4岁）,平均体重是15Kg（9.4～30.8Kg）,肾脏替代治疗平均持续时间是62h（10～212h）。术后共8例（72.7%）患者死亡,其中4例在CVVHDF治疗期间死亡,均死于多器官功能障碍综合征（MODS）,并且肾功能未恢复;另外4例中2例死于心力衰竭,1例死于呼吸衰竭,1例死于蛛网膜下腔出血。治疗24h后存活患者血尿素氮（BUN）和肌酐（Scr）均明显降低（P〈0.05）,共7例（63.6%）患儿肾功能恢复。治疗48h后患者平均动脉压（MAP）明显上升,心率（HR）及中心静脉压（CVP）下降（P值均〈0.05）。结论CVVHDF是治疗心内直视术后合并ARF患儿的有效手段,可以改善患者肾功能,稳定血流动力学,但患儿预后仍主要取决于原发病及术后心力衰竭严重程度。

Continuous veno-venous hemodiafiltration in children with acute renal failure after cardiac surgery

Objective To evaluate the effect of continuous veno-venous hemodiafiltration （CVVHDF） on acute renal failure （ARF） following cardiac surgery in children. Methods CVVHDF therapy was applied to 11 ARF children following cardiac operation from July 2004 to July 2008. Results Of the 11 treated children, the mean age at the onset of CVVHDF was 30.6 months （6 months～12.4 years）, and the mean body weight was 15 kg （9.4～30.8kg）. The mean duration of renal replacement therapy was 62 hours （10～212 hours）. Eight patients （72.7%） died in postoperative period, of whom 4 patients died of multiple organ dysfunction syndrome during CVVHDF without recovery of renal function, 2 died of cardiac failure, one died of respiratory failure, and one died of subarachnoid hemorrhage. In survival patients, BUN and Scr decreased after CVVHDF for 24-hour （P 〈 0.05）. Recovery of renal function was found in 7 patients （63.6%）. After CVVHDF for 48-hour, mean artery pressure （MAP） increased significantly （P 〈 0.05）, and heart rate （P〈 0.05） and central venous pressure （P〈 0.05） decreased. Conclusions CVVHDF may be an effective measure for children with renal failure after cardiac surgery. CVVHDF improves renal function and stabilizes hemodynamics. However, the prognosis is predominantly determined by the primary diseases and the degree of postoperative heart failure.