腹膜透析时机对先天性心脏病患者术后临床效果的影响

目的 探讨复杂先天性心脏病术后腹膜透析(PD)的应用时机.方法 65例复杂性先天性心脏病患儿随机分为A组(33例)与B组(32例),A组术后于使用利尿药效果差或尿量＜0.5ml·kg-1·h-1时即采用PD,B组于尿量＜0.5 ml·kg-1·h-1持续6h后采用PD,观察比较两组患儿的生存效果和PD前后各项指标的变化.结果 PD治疗l-15 d后,65例患儿PD前尿量(1.03±0.43)ml·kg-1·h-1、血钾(5.52±0.94) mmol/L、血尿素氮(19.54±3.73) mmol/L、血肌酐(143.77±42.89) mmol/L,PD后分别为(2.85±0.61)ml· kg-1· h-1、(4.32±0.57) mmol/L、(9.54±3.42) mmol/L、(120.01±49.22)mmol/L,PD前后各项指标变化差异均有统计学意义(t =5.22、3.46、4.89、4.77,均P＜0.05).A组患儿尿量逐渐改善及恢复28例(84.85％),明显优于B组的17(53.12％)(x2=5.18,P＜0.05),A组病死率9.09％ (2/33),明显低于B组的l8.75％ (6/32)(x2=5.32,P＜0.05).结论 PD是复杂先天性心脏病术后并发心、肾功能不全时的有效治疗手段,及早应用临床效果显著.

The application of peritoneal dialysis ( PD ) in the children with complex congenital heart disease after surgery

Objective To investigate the efficacy of peritoneal dialysis （PD） in the children with complex congenital heart disease after surgery. Methods 65 children with complex congenital heart disease were divided into group A（ 33 cases） and group B （32 cases ）. Group A was given PD when diuretics or urine output was less than 0. 5ml per hour,while group B was given PD when urine output was less than 0.5ml per hour after 6h. The survival effect and indicators of PD before and after treatment were observed. Results The effective rate of group A （84. 85% ）was significantly better than group B （53. 12% ） （X2 = 5. 18, P 〈 0. 05 ）. The fatality rate of group A （ 9. 09 % ） was significantly lower than group B （ 18.75 % ） （χ2 = 5.32, P 〈 0.05 ）. The renal function was significantly improved. Urine output increased to the normal level, serum potassium, blood urea nitrogen, serum creatinine concentration were effectively controlled, the changes of indicators had significant differences before and after PD （t = 5.22,3.46,4.89,4.77, all P 〈 0.05 ）. Conclusion PD was an effective support method for heart, renal insufficiency after the surgery of complex congenital heart disease, and it had good clinical effect for early application.